Nonalcoholic Fatty Liver Disease

Medically Reviewed By William C. Lloyd III, MD, FACS
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What is nonalcoholic fatty liver disease?

Although alcohol use is commonly associated with fat accumulation in the liver, fatty liver disease in this discussion refers to the accumulation of excess fat in the liver, specifically in the absence of excess alcohol consumption. The liver is an organ in the digestive system that assists the digestive process and carries out many other essential functions. These functions include producing bile to help break down food into energy; creating essential substances, such as hormones; cleaning toxins from the blood, including those from medication, alcohol and drugs; and controlling fat storage and cholesterol production and release.

When fat accumulates in the liver of someone who drinks little or no alcohol, the symptom is usually considered to be part of a group of conditions called nonalcoholic fatty liver disease (NAFLD) that affects up to 20% of adults. It is the most common liver disorder among adults in industrialized countries. Within this group, some people develop a more serious condition called nonalcoholic steatohepatitis (NASH), in which the liver cells become inflamed and, in some cases, are replaced by scar tissue. Once the scarring, or cirrhosis, occurs, the liver begins to sustain permanent damage. (Source: ACG).

You are at greater risk for developing NAFLD if you are obese and have diabetes, elevated blood lipids (high cholesterol and triglycerides), metabolic syndrome, and high blood pressure. As the rate of obesity has grown rapidly, NAFLD and NASH have become more prevalent.

The causes of NASH are not fully understood, but most researchers support the notion of insulin resistance. Most people with NAFLD do not have symptoms of the condition. If NASH develops, symptoms of liver inflammation (hepatitis) may occur.

Seek immediate medical care (call 911) for serious symptoms of liver disease, such as constant weakness, dizziness, confusion, difficulty thinking or understanding, extreme fatigue, fainting, fever (especially if combined with a swollen abdomen or swollen legs), vomiting blood, or blood in your stool.

Seek prompt medical care if you have been treated for obesity, diabetes, metabolic syndrome, or high blood pressure and you have symptoms that include extreme fatigue, feeling of fullness or pain in the middle or upper right side of your abdomen, abdominal pain, nausea with or without vomiting, nosebleeds or bleeding gums, pale or clay-colored stools, small red blood vessels on the skin, yellowing of the skin or whites of the eyes, unexplained weight loss, or weakness.

What other symptoms might occur with nonalcoholic fatty liver disease?

Fatty liver may accompany other symptoms, which vary depending on the underlying disease, disorder or condition. Symptoms that frequently affect the digestive tract may also involve other body systems.

Common liver and digestive system symptoms

Symptoms that frequently affect the liver and digestive system may accompany fatty liver. These include:

  • Abdominal pain

  • Abdominal swelling, distention or bloating

  • Bloody stool (blood may be red, black, or tarry in texture)

  • Fullness or pain in the right side of the abdomen

  • Loss of appetite

  • Nausea with or without vomiting

  • Vomiting blood or black material (resembling coffee grounds)

Other symptoms of fatty liver

Skin symptoms can include the following:

  • Nosebleeds or bleeding from the gums

  • Red, spidery, or star-shaped blood vessels

  • Severe fatigue

  • Skin discoloration

  • Unexplained weight loss

  • Yellowing of the skin and whites of the eyes (jaundice)

Symptoms that might indicate a serious condition

In some cases, fatty liver can develop into nonalcoholic steatohepatitis (NASH), which can be a serious condition that should be evaluated immediately in an emergency setting. Seek immediate medical care if you, or someone you are with, have any of these serious symptoms including:

What causes nonalcoholic fatty liver disease?

Conditions that are associated with nonalcoholic fatty liver disease (NAFLD) are obesity, diabetes, elevated blood lipids (high cholesterol and triglycerides), metabolic syndrome, and high blood pressure. Corticosteroids and certain drugs used for cancer treatment are known to cause NAFLD.

The reasons why this condition may progress to the more serious form, nonalcoholic steatohepatitis (NASH), are not fully understood, but certain biochemical abnormalities have been identified that may be related to this transition.

Questions for diagnosing the related cause of NAFLD

To diagnose your condition, your doctor or licensed health care practitioner will ask you several questions related to your symptoms including:

  • How long have you had these particular symptoms?

  • Have you had any abdominal swelling, distention or bloating? Any pain?

  • Have you had a fever or chills?

  • Have you seen changes in your skin? A change in color? New blood vessels? Any itching?

  • Have you had any other symptoms?

  • What medications are you taking?

What are the risk factors for nonalcoholic fatty liver disease?

Risk factors for NAFLD include:

  • Elevated blood lipid levels

  • High blood pressure (hypertension)

  • Metabolic syndrome (diabetes or prediabetes with insulin resistance, elevated lipids, and high blood pressure)

  • Obesity

  • Older age, although younger people and even children can develop NAFLD

Reducing your risk of NAFLD

While the exact cause is not known, practicing a healthy lifestyle is the best way to reduce your risk of developing NAFLD because it will help prevent NAFLD risk factors.

You can reduce your risk by:

  • Eating a heart-healthy diet

  • Exercising about five days a week

  • Getting liver function tests if you are taking drugs linked to fatty liver

  • Maintaining a healthy weight for you or losing weight if you are overweight or obese

  • Managing medical conditions, such as taking prescribed medicine for high blood pressure or prediabetes

How is nonalcoholic fatty liver disease treated?

There are no specific medications designed to treat NAFLD. The most common treatment for NAFLD is weight loss to reduce body fat and liver fat. Regular exercise will reduce body fat and liver fat and lower cholesterol. Gradual but steady weight loss is better than drastic weight loss. A healthy diet high in vegetables, whole grains, lean meats, and ‘good’ dietary fat—along with portion control—will help with weight loss. 

Treating underlying medical conditions related to NAFLD is vital. This means taking prescribed medicine for prediabetes, diabetes, and high blood pressure.

Researchers are actively testing different medications and combination therapy to reduce liver fat content in people with NAFLD. Dapagliflozin (Farxiga), a drug for type 2 diabetes shows some promise as a potential NAFLD treatment. It reduced signs of liver injury, but more research is necessary before it is incorporated as a standard treatment. Omega-3 carboxylic acids, in combination with dapagliflozin, reduced liver fat in patients in the clinical trials.

There are limited options for improving NALFD once liver inflammation (steatohepatitis) and scarring occur. Pioglitazone (Actos) is a medicine for type 2 diabetes that seems to improve signs of NASH in some people. Supplementation with vitamin E may be a short-term option for people who develop NASH but do not have diabetes. Talk with your doctor about what options are safe for you.

Liver transplant is an option for people with liver failure.

If you have NAFLD or NASH, do not take any medicines, herbs or vitamin supplements without first consulting with your doctor. Keep in mind that one function of the liver is to clean toxins from the blood, and some substances can cause liver damage or make it worse.

What are the potential complications of nonalcoholic fatty liver disease?

Because fatty liver can be due to serious diseases, failure to seek treatment can result in serious complications and permanent damage. Once the underlying cause is diagnosed, it is important for you to follow the treatment plan that you and your health care professional design specifically for you to reduce the risk of potential complications including:

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2022 Jan 11
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
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