Non-Alcoholic Fatty Liver Disease: Symptoms, Causes, Treatment & Prevention

Non-alcoholic fatty liver disease (NAFLD) is a very common liver disease in which there is excessive accumulation of fat within the liver cells causing inflammation and in later stages, scarring. As the name suggests, fat deposition is due to reasons other than alcohol consumption. As alcohol also causes NAFLD and later liver fibrosis called cirrhosis.

Normally, the fat percentage in the liver is less than 10% but certain factors like excessive alcohol consumption or obesity will cause this fat percentage to increase within the cells and result in inflammation and the release of various inflammatory chemicals causing liver inflammation called hepatitis which can progress to scarring called cirrhosis and hepatic failure.

Symptoms of Non-Alcoholic Fatty Liver Disease

Usually, the signs and symptoms will remain ignored in the early stage and the mild elevation of AST and ALT gets unnoticed, general symptoms like the following can be seen:

1. Fatigue 
2. Pain
3. Loss of appetite 
4. Weight loss 
5. Nausea 
6. Pale skin 
7. Oedema 

Later when there is more destruction of the liver tissue, symptoms like the following will be present:

1. Portal hypertension causes the vessels around the naval to enlarge 
2. Spleen enlargement 
3. Abnormal build-up of fluid in the belly
4. Jaundice with yellow skin and yellow eyes 
5. Swollen ankles and feet

Causes

1. Obesity 
2. Insulin resistance 
3. Hyperglycaemia/ Diabetes mellitus 
4. Drugs like paracetamol, isoniazid, OCP
5. Metabolic diseases like Wilson’s disease, Alpha 1 antitrypsin deficiency, Hemosiderosis
6. Autoimmune hepatitis 

Risk Factors

All of the following increases the amount of fats in the blood which increases the chances of deposition of fats within the hepatic cells causing NAFLD-

1. High cholesterol
2. High levels of triglycerides in the blood
3. Metabolic syndrome causing hypertension, diabetes etc 
4. Central obesity 
5. Polycystic ovary syndrome
6. Type 2 diabetes
7. hypothyroidism
8. hypopituitarism
9. Age over 50
10. Diseases like Wilson’s and hemosiderosis

Stages of Non-Alcoholic Fatty Liver Disease

1. Simple fatty liver (steatosis) is a harmless build-up of fat in the liver cells that usually doesn’t cause any harm. It usually gets diagnosed incidentally while testing for something else.
2. Non-alcoholic steatohepatitis (NASH) is a more serious and advanced form of Non-Alcoholic Fatty Liver Disease (NAFLD), where the fat deposition inside the cells causes inflammation and tissue damage.
3. Fibrosis is a state of persistent inflammation that causes scar tissue to form in the liver. The liver loses functional abilities gradually and the patient experiences mild symptoms.
4. Cirrhosis is the most severe stage, occurring after years of inflammation, where the liver shrinks and becomes scarred and lumpy; this damage is permanent and usually leads to complete liver failure and can rarely progress to hepatic carcinoma.

Complications

NAFLD can progress to steatohepatitis where there is excessive inflammation which can rarely result in cirrhosis and complete liver failure causing the following complications:

1. Hepatorenal syndrome: This is renal failure due to toxin build-up in the body as the liver isn’t able to clear out the toxins from the body
2. Clotting disorders: this is due to various clotting proteins deficiency which is originally produced from the liver 
3. Hepatic encephalopathy: here there is improper brain functioning and disorientation seen in the person due to the non-clearing of ammonia from the blood by the liver 
4. Immune disorders: due to Globin protein deficiency which forms the antibodies 
5. Hormonal imbalance: liver also has the function of metabolism of steroid hormones which doesn’t happen in cirrhosis leading to gonadal dysfunction and atrophy 

Diagnosis of Non-Alcoholic Fatty Liver Disease

1. Blood tests/ Liver function tests (LFTs): this includes the enzymatic tests for AST, ALT and various other hepatic enzymes and lipid profile and complete blood count etc.
2. Imaging studies are done to assess the shape, size and abnormalities of the liver.
3. Biopsy: this shows the abnormality in the liver tissue and helps in identifying the stage of the disease.

Treatment

If you have mild NAFLD where they are no prominent signs and symptoms then doing the following is sufficient enough to reverse the damage:

1. Maintaining a healthy weight and healthy diet 
2. Lifestyle changes

But if the problem is a bit severe and there is jaundice, portal hypertension etc then the doctor prescribes medications like:

1. Drugs to lower the cholesterol and triglycerides in blood 
2. Anti-diabetic drug if diabetes is present 
3. Identification and treatment of underlying conditions

If severe hepatic damage has already occurred then the only treatment available is a liver transplant.

Prevention of Non-Alcoholic Fatty Liver Disease

1. Healthy diet
2. Regular physical activity
3. Healthy BMI: between 18.9 to 24.5 

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