Fatty Liver

What is fatty liver?

Nonalcoholic fatty liver disease (NAFLD) is a common chronic liver disease that occurs when excess fat is deposited in the liver of people who drink little or no alcohol. It can range from 'good fat' or simple fat to 'bad fat' or non-alcoholic steatohepatitis (NASH). NASH can lead to liver cirrhosis and liver cancer.

What are the symptoms of NAFLD?

NAFLD usually does not cause symptoms. If symptoms are present, they may be non-specific type symptoms of tiredness, nausea and discomfort over the right upper abdomen. However, if NAFLD progresses to cirrhosis, signs and symptoms of cirrhosis may appear.

What are the risk factors for NAFLD?

Risk factors for NAFLD include:

• Diabetes
  
• Obesity (BMI>25 kg/m2 in Asian people)
• Increased belly fat (central obesity) – waistline >90cm in Asian men or >80cm in Asian women
• Cholesterol problems
  
• Hypertension
  
• Metabolic syndrome
  
• Other associated conditions like obstructive sleep apnoea (OSA), polycystic ovary syndrome (PCOS), underactive thyroid (hypothyroidism), underactive pituitary (hypopituitary)

How is NAFLD diagnosed?

NAFLD is diagnosed by a combination of history, physical examination, blood tests and imaging studies of the liver.

• Liver function tests such as liver enzymes (ALT, AST) may be elevated
• Ultrasound, CT or MRI scan may show fatty liver
• Other blood tests may be needed to predict severity of disease or exclude other liver diseases
• Liver biopsy may be required to stage the disease

How is NAFLD treated?

Treatments may include:

Lifestyle modifications

• Weight loss
• Diet
• Exercise
  

Treatment of associated factors

• Control of diabetes, hypertension, obesity, cholesterol
• Medications
  

References

1. Wang, H., Sun, Y., Zhao, J., Wang, Y., Hu, D., Zhang, L., Liu, X., Zhang, Y., Huang, H., & Zhang, Y. (2024). Advances in the research of metabolic dysfunction-associated steatotic liver disease and its pathogenesis. International Journal of Molecular Medicine, 53(2), 1–11. https://www.spandidos-publications.com/10.3892/ijmm.2024.5412

2. Chalasani, N., Younossi, Z., Lavine, J. E., Diehl, A. M., Brunt, E. M., Cusi, K., Charlton, M., & Sanyal, A. J. (2018). The diagnosis and management of nonalcoholic fatty liver disease: Practice guidance from the American Association for the Study of Liver Diseases. Hepatology, 67(1), 328–357. https://pmc.ncbi.nlm.nih.gov/articles/PMC5643281/

3. Canadian Liver Foundation. (n.d.). Introduction to MASLD & MASH. https://fattyliver.ca/blog/f/introduction-to-masld-mash