Fatty Liver (NAFLD)

Fatty liver is the accumulation of triglycerides and other fats in the liver cells. Fatty liver could be alcohol related or non-alcohol related. Here I will be explaining about Non-Alcoholic Fatty Liver Disease (NAFLD). Fatty liver is the most common form of Non-Alcoholic Fatty Liver Disease and is not serious. However, a small group of people with fatty liver can develop a more serious condition called NASH (Non-Alcoholic SteatoHepatitis). In NASH, fat in the liver can trigger inflammation leading to liver inflammation, scarring (fibrosis) and liver cell death. Inflammation of the liver is also known as hepatitis.

Non-alcoholic steatohepatitis (NASH) is a potentially serious condition and can lead to cirrhosis of the liver. Some people who develop cirrhosis may even need a liver transplant.

What are the symptoms of Non-Alcoholic Fatty Liver Disease?

Most people have no symptoms. Fatty liver may be found on a routine ultrasound scan or an abnormal liver function test is picked up in a routine blood test.

Some people may complain of fatigue or abdominal pain.

What are the causes for 
Non-Alcoholic Fatty Liver Disease?

Obesity is thought to be the most common cause of fatty liver. Around two thirds of obese adults may have fatty liver and a smaller percentage may have non-alcoholic steatohepatitis. Type 2 diabetes, prediabetes, overweight, hypertension and high cholesterol contributes to fatty liver.

How is NAFLD diagnosed?

Some people with NAFLD can be present with normal liver blood tests. The diagnosis of NAFLD is confirmed by a liver ultrasound, which shows accumulation of fat in the liver.

Currently, a liver biopsy is the current gold standard in diagnosis of Non-Alcoholic Fatty Liver Disease and NASH. However liver biopsy is an invasive procedure andthe risk of complications including pain and bleeding exists.

Non-invasive scoring system using some blood tests helps to ascertain the diagnosis of NAFLD or non-alcoholic steatohepatitis. The scoring systems available include BARD score, FIB-4 score and Non-Alcoholic Fatty Liver Disease fibrosis score.

Fibroscan helps to find out the elasticity of liver tissue.

A combination of factors can determine the stage of non-alcoholic steatohepatitis and the presence or absence of cirrhosis.

It is important to exclude other conditions before Non-Alcoholic Fatty Liver Disease is diagnosed. Conditions excess alcohol intake, viral hepatitis, autoimmune liver disease, medications and some other liver disease.

How is NAFLD treated?

About 20% of people with NAFLD progresses to non-alcoholic steatohepatitis (NASH). Non-alcoholic steatohepatitis, in turn can lead to liver cirrhosis. About 20 % of the people with NASH can lead to liver failure and hepatocellular carcinoma (liver cancer).

So, investigations will help in finding out the stage of the Non-Alcoholic Fatty Liver Disease/non-alcoholic steatohepatitis. Once this is done, life style advice including weight loss is advised. Currently there is no specific medications in the treatment of non-alcoholic steatohepatitis.

Dr Chinnadorai Rajeswaran is a consultant Physician specialising in Endocrinology, Diabetes and Obesity. As a private endocrinologist he  has private endocrine, diabetes and weight loss clinics in Harley Street, London, Chennai (India), Claremont Hospital, Sheffield, Nuffield Hospital, Leeds and Simplyweight, Bradford.

He has face to face consultations with people from Barnsley, Rotherham, Chesterfield, Doncaster, Wakefield, Huddersfield, Bradford, Harrogate, Leeds, Sheffield, London and Chennai (India). He also offers video consultations.

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