Nonalcoholic Fatty Liver Disease (NAFLD)
Nonalcoholic fatty liver disease (NAFLD) is a common disease of the liver. It occurs when you have too much fat in the liver. If NAFLD is severe, it can cause liver damage that seems like the damage caused by drinking too much alcohol. But NAFLD is not caused by drinking alcohol. This sheet tells you more about NAFLD and how it can be managed.
How the liver works
The liver is an organ in the upper right side of the belly (abdomen). It has many important jobs. These include:
Breaking down (metabolizing) proteins, carbohydrates, and fats
Making a substance called bile that helps break down fats
Storing and releasing sugar (glucose) into the blood to give the body energy
Removing toxins from the blood
Helping with blood clotting
A healthy liver may contain some fat. But if too much fat builds up in the liver, this causes NAFLD. NAFLD can be mild, causing fatty liver. Or it can be more severe and show inflammation, as well as the fat. This can cause non-alcoholic steatohepatitis (NASH).
Fatty liver. With fatty liver, the liver simply has more fat than normal. This extra fat usually does not harm the liver.
NASH. With NASH, the fatty liver becomes inflamed over time. NASH is serious because it can lead to scarring of the liver (fibrosis). Over time, the scarring may lead to cirrhosis of the liver. This can eventually cause liver failure or liver cancer.
Causes and risk factors of NAFLD
Doctors don't know what causes NAFLD. But certain things make the problem more likely to happen. These include:
Prediabetes or diabetes
High levels of fat found in the blood (cholesterol and triglycerides)
Being exposed to certain medicines
Symptoms of NAFLD
Most people with NAFLD have no symptoms. If symptoms do occur, they can include:
Loss of appetite
Nausea and vomiting
Belly pain and cramping
Yellowing of the skin and eyes (jaundice), as well as dark urine, or light-colored stools
Swelling in the belly or legs
Your healthcare provider may think you have NAFLD if routine blood tests show high levels of liver enzymes. This may mean you have a liver problem. You may need one or more imaging tests, such as an ultrasound, CT, or MRI. You may need more blood tests to look for other causes of liver disease. You may also need a liver biopsy. During this test, a hollow needle is used to remove a tiny tissue sample from your liver. This tissue is then checked in a lab. This test can find signs of damage to liver tissue. It can also help figure out the cause of the damage and tell the difference between fatty liver and NASH.
Treatment for NAFLD varies for each person. The best early treatment is to treat any underlying conditions causing metabolic syndrome. This is the name for a group of conditions that includes:
High blood pressure
High levels of cholesterol and triglycerides
Being overweight or obese
Your healthcare provider will monitor your health and treat any symptoms or underlying health problems you have. Your provider will also work with you to control your risk factors. This will make liver damage less likely. In fact, treating those underlying conditions can often improve liver disease. You may need to take certain medicines, but no medicine will cure NAFLD. This is why treating the underlying conditions is most important. Your plan may include:
Losing extra weight
Getting regular exercise
Controlling diabetes and high cholesterol or triglyceride levels
Taking medicines and vitamins as prescribed by your provider
Not drinking alcohol
Eating a healthy and balanced diet
Living with NAFLD
If NAFLD is caught early, it can be managed with treatment. Your healthcare provider will discuss further treatment choices with you as needed.
Be sure to ask your provider about recommended vaccines. These include vaccines for viruses that can cause liver disease.
July 28, 2018
Epidemiology, clinical features, and diagnosis of nonalcoholic fatty liver disease in adults. UpToDate., Natural history and management of nonalcoholic fatty liver disease in adults. UpToDate., Patient Education: NAFLD_NASH (Beyond the Basics). UpToDate., Recommended Immunization Schedule for Adults Aged 19 Years of Older, U.S., 2017. Kim D. Annals of Internal Medicine. 2017;166(3):209-18., The Diagnosis and Management of Non-alcoholic Fatty Liver Disease: Practice Guideline. Chalasani, N. Gastroenterology (2012) 142;7 s1592-s1609
Cunningham, Louise, RN,Fetterman, Anne, RN, BSN,Image reviewed by StayWell medical illustration team.,Lehrer, Jenifer, MD