From the Guidelines
Fatty liver disease is a condition where excess fat builds up in your liver cells, and it's crucial to address it through lifestyle changes to prevent progression to more severe liver damage. This condition can develop in two main ways: from drinking too much alcohol (alcoholic fatty liver disease) or from other causes like obesity, diabetes, or high cholesterol (non-alcoholic fatty liver disease or NAFLD) 1. Many people with fatty liver have no symptoms initially, but you might experience fatigue, discomfort in your upper right abdomen, or a feeling of fullness. If left untreated, fatty liver can progress to inflammation, scarring (fibrosis), and eventually cirrhosis, which permanently damages your liver.
Key Facts About Fatty Liver Disease
- Non-alcoholic fatty liver disease (NAFLD) is a spectrum of liver diseases comprised of nonalcoholic fatty liver (NAFL), which has a negligible risk of progression, and nonalcoholic steatohepatitis (NASH), which has a higher risk of liver disease progression 1.
- NAFLD is estimated to affect approximately 25% of the world’s adult population and is the leading cause of chronic liver disease globally 1.
- The clinical management of NAFLD varies depending on the disease stage, but diet and lifestyle changes and the management of underlying metabolic risk factors are the cornerstone of treatment for all patients 1.
Treatment and Management
Lifestyle modifications, including weight loss and exercise, form the cornerstone of NAFLD treatment and should be strongly encouraged 1.
- Losing weight gradually through healthy eating and regular exercise can help reduce fat deposits in the liver.
- Avoiding alcohol completely, controlling diabetes and cholesterol, and limiting medications that strain your liver are also important.
- There's no specific medication for fatty liver, but treating underlying conditions helps.
- Regular follow-up with blood tests and sometimes imaging helps monitor your progress and catch any complications early.
Importance of Early Intervention
The good news is that early-stage fatty liver is often reversible with these lifestyle changes 1. Your liver has remarkable healing ability, and with proper care, the fat deposits can decrease and liver function can improve. It's essential to address fatty liver disease promptly to prevent progression to more severe liver damage and reduce the risk of associated complications, such as cardiovascular disease and liver cancer 1.
From the Research
What is Fatty Liver Disease
Fatty liver disease, also known as nonalcoholic fatty liver disease (NAFLD), is a condition where excess fat builds up in the liver of people who drink little or no alcohol 2. There are two forms of NAFLD: nonalcoholic fatty liver (NAFL) and nonalcoholic steatohepatitis (NASH). NAFL is defined as 5% or greater hepatic steatosis without hepatocellular injury or fibrosis, while NASH is defined as 5% or greater hepatic steatosis plus hepatocellular injury and inflammation, with or without fibrosis.
Risk Factors
The following are some of the established risk factors for NAFLD:
- Obesity
- Metabolic syndrome
- Type 2 diabetes mellitus
- Individuals with these conditions are at highest risk of developing NAFLD 2
Symptoms and Diagnosis
NAFLD is often asymptomatic, and screening is not currently recommended, even in high-risk patients 2. However, NAFLD should be suspected in patients with:
- Elevated liver enzymes
- Hepatic steatosis on abdominal imaging that are found incidentally Once other causes, such as excessive alcohol use and hepatotoxic medications, are excluded, risk scores or elastography tests can be used to identify those who are likely to have fibrosis that will progress to cirrhosis.
Treatment
The primary treatment for NAFLD is weight loss through diet and exercise 2. Other treatments, such as:
- Bariatric surgery
- Vitamin E supplements
- Pharmacologic therapy with thiazolidinediones or glucagon-like peptide-1 analogues have shown potential benefit, although data are limited, and these therapies are not considered routine treatments 2, 3, 4, 5, 6.
Benefits of Vitamin E
Vitamin E has been shown to have a beneficial effect on NAFLD, including: