Nonalcoholic fatty liver disease or NAFLD is caused by excess fat that accumulates in the liver, not related to excessive alcohol use. NAFLD is similar to alcoholic liver disease but can happen in people who rarely or never drink. Fatty liver disease is a worldwide epidemic occurring in 1 out of 4 adults. It is the most common cause of end stage liver disease and the number 2 cause for liver transplantation. About 7% of people with NAFLD progress to NASH. When this happens, liver cells become injured and inflamed and form scarring known as fibrosis. Fibrosis leads to cirrhosis and increases the risk for liver cancer. Risk factors for progression include:
NAFLD is often a silent disease with few or no symptoms. NAFLD can cause fatigue which may be overlooked during a medical evaluation for tiredness. Other symptoms include nausea, yellowing of the eyes or discomfort in the upper right side of the abdomen.
NAFLD is suspected by abnormal liver tests, primarily elevated liver enzymes (AST-aspartate aminotransferase, ALT-alanine aminotransferase), high ferritin or low platelets. Suspected NAFLD is then confirmed with an imaging study such as ultrasound, CT or MRI of the abdomen. Traditionally, the diagnosis of NASH has been made by liver biopsy, but this can be painful and expensive. New noninvasive tools have become another way to detect fibrosis in patients with fatty liver disease.
The management of NAFLD consists of treating the liver disease alongside the associated metabolic conditions such as obesity, diabetes and abnormal cholesterol. Weight loss with a diet plan is one of the most effective treatments for NAFLD while improving all of the metabolic conditions and decreasing the risk of heart disease. Several dietary approaches to NAFLD have been shown to be effective including fast weight loss programs. Although there are no approved drug therapies for NAFLD, several diabetes medications and vitamin E have been shown to be effective. Weight loss medications are also beneficial for NAFLD although there is very little research. A type of weight loss surgery known as metabolic surgery is an effective treatment. New pharmaceutical agents that directly target NASH are in clinical trials. Liver transplantation is also a treatment for patients with end stage liver disease.
To learn more about diagnosis and management of fatty liver disease, call Atlanta Endocrine Associates or schedule an appointment online.
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