Non-alcoholic fatty liver disease (NAFLD)
নন-অ্যালকোহলিক ফ্যাটি লিভার ডিজিজ (NAFLD)
Non-alcoholic fatty liver disease (NAFLD) is the name given to a group of conditions that happen when fat builds up in the liver. It is most often seen in people who are overweight or obese.
A healthy liver normally holds little or no fat. Estimates suggest that as many as 1 in every 3 people in the UK are in the early stage of NAFLD, when only small amounts of fat have collected in the liver.
At this early stage, NAFLD usually does not cause any real harm. But if it is allowed to progress, it can lead to serious liver damage, including cirrhosis. Carrying high levels of fat in the liver is also linked to a greater chance of developing problems such as diabetes, heart attacks and strokes.
The reassuring part is that if NAFLD is caught and managed early, it is possible to stop it from getting worse and even bring down the amount of fat in your liver.
Stages of NAFLD
NAFLD develops through 4 main stages.
Most people never go beyond the first stage, and many do not even realise they have it. Only in a small number of cases does it progress further and eventually cause liver damage if it is not picked up and managed in time.
The main stages of NAFLD are:
- simple fatty liver (steatosis): a largely harmless build up of fat in the liver cells, which is often only found when tests are done for some other reason
- non-alcoholic steatohepatitis (NASH): a more serious form of NAFLD in which the liver has become inflamed; this is thought to affect up to 5% of the UK population
- fibrosis: a stage where ongoing inflammation causes scar tissue to form around the liver and the blood vessels nearby, though the liver can still work normally
- cirrhosis: the most severe stage, developing after years of inflammation, in which the liver shrinks and becomes scarred and lumpy; this damage is permanent and can lead to liver failure (when the liver stops working properly) and liver cancer
Fibrosis or cirrhosis can take years to develop. This is exactly why making changes to your lifestyle early on matters so much, as it can help stop the disease from advancing further.
Am I at risk of NAFLD?
Your risk of NAFLD is higher if you:
- are obese or overweight, particularly if you carry a lot of fat around your waist (giving an "apple like" body shape)
- have type 2 diabetes
- have high blood pressure
- have high cholesterol
- are over the age of 50
- smoke
That said, NAFLD has also been found in people with none of these risk factors, including young children.
It may look very similar to alcohol related liver disease (ARLD), but NAFLD is not caused by drinking too much alcohol.
Common Symptoms
⚠️ This symptom list is for educational purposes. Having these symptoms does not mean you have this condition. See a doctor for proper diagnosis.
Medicines Commonly Used
⚠️ These medicines are commonly used for confirmed diagnoses of this condition. This is NOT a recommendation or prescription. Treatment must be determined by your doctor.
No medicines have been linked to this condition yet.
Diagnosis
NAFLD is often picked up when a routine blood test, called a liver function test, comes back abnormal and other liver conditions such as hepatitis have been ruled out. That said, blood tests don't always catch NAFLD, so a normal result doesn't rule it out completely.
The condition may also be spotted during an ultrasound scan of the tummy, a painless scan that uses sound waves to build a picture of the inside of the body.
If you're diagnosed with NAFLD, your doctor may want to run further tests to work out which stage the condition has reached. This could mean a special blood test or another kind of ultrasound scan called a Fibroscan. In some cases, a small sample of liver tissue, known as a biopsy, is taken with a needle and sent to a laboratory for analysis.
Treatment
Most people with NAFLD do not go on to develop serious problems, but once you have been diagnosed it is worth taking steps early to stop the condition getting any worse.
There is currently no specific medicine that treats NAFLD itself, but making healthy lifestyle changes can help, and your doctor may recommend treatment for related conditions such as high blood pressure, diabetes and high cholesterol, or for any complications that arise.
You may also be advised to attend regular appointments so your doctor can check how well your liver is working and watch for any new problems.
Adopting a healthy lifestyle is the main way of managing NAFLD, and several changes can help. Try to lose weight, aiming for a BMI of 18.5 to 24.9. Losing more than 10% of your body weight can remove some fat from the liver and improve NASH if you have it. Eat a balanced diet that is high in fruits, vegetables, protein and carbohydrates, but low in fat, sugar and salt, and try having smaller portions of food as well. Exercise regularly, aiming for at least 150 minutes of moderate intensity activity such as walking or cycling each week, since all types of exercise can help improve NAFLD even if you do not lose weight. If you smoke, stopping can help lower your risk of problems such as heart attacks and strokes. NAFLD is not caused by alcohol, but drinking can make the condition worse, so it is best to cut down or stop drinking altogether.
There is not yet any medicine that treats NAFLD directly, but various medicines can help manage the problems linked to the condition. For example, your doctor may prescribe medication for high blood pressure, high cholesterol, type 2 diabetes or obesity.
If severe cirrhosis develops and your liver stops working properly, you may need to be placed on the waiting list for a liver transplant. For adults, the average wait for a transplant from a recently deceased donor is 145 days. It may also be possible to receive a transplant using a section of liver taken from a living donor. Since the liver can regenerate itself, both the transplanted section and the part remaining in the donor are able to grow back to a normal size.