(Non-Alcoholic Fatty Liver Disease)
What is Fatty Liver?
Fatty liver , which is also known as Non-alcoholic fatty liver disease (NAFLD) is a condition where fat accumulates in the liver. Fat accumulation also occurs in people who drink too much alcohol, but NAFLD is seen in those that drink little or no alcohol. This is a very common condition and is important because fat accumulation can lead to inflammation called non-alcoholic steatohepatitis (NASH). NASH in turn can lead to scarring in the liver with serious consequences.
Who is at risk?
Fatty liver is associated with being overweight and is very common in the West, affecting up to 30% of the general population. Up to 10% of those with NAFLD develop NASH. It is not known exactly why some get inflammation while other do not, but risk factors include diabetes, obesity, high cholesterol, high blood pressure and some medications.
How is NAFLD diagnosed?
Most people with NAFLD/NASH do not have symptoms, so it is underdiagnosed. Very often NAFLD is found by coincidence when blood tests or imaging are performed for other reasons. NAFLD may be diagnosed based on blood tests and ultrasound, but sometimes a liver biopsy is needed to determine whether NASH is present.
Importantly, people with NAFLD may have normal liver blood tests so it is a sensible idea to think about further tests in those with the risk factors mentioned above.
Does NAFLD progress?
If there is inflammation present (ie NASH) then this can lead to accumulation of scarring in the liver. When the scarring becomes extensive, this is called cirrhosis, which has significant health consequences. One way of determining whether there is significant liver damage in patients with NAFLD is with special scans such as Transient Elastography, which is a bit like an ultrasound, and measures liver stiffness, a marker of scarring.
How is NAFLD treated?
There is no current approved medication for NAFLD. The mainstay of treatment is addressing risk factors i.e.: weight loss, controlling diabetes, treating high cholesterol and blood pressure and avoiding medications that are associated with NASH. People with NAFLD need to have regular health checks to monitor whether there has been progression of disease and address risk factors.