NAFLD & NASH Fatty Liver Disease

 Non-alcoholic fatty liver disease (NAFLD) is a condition of the liver that is characterized by fat accumulation (also known as steatosis) in the liver, occurring in individuals who consume little or no alcohol (equal to or less than two drinks per day in men and one drink per day in women). NAFLD is currently thought to be the most common type of liver disease in both adults and adolescents in the U.S. with rates of up to 25-30% of the U.S. population. 

The presence of fat in the liver along with inflammation and varying amounts of scarring (fibrosis). 

Patients with NAFLD/NASH tend to also have one or more features of  metabolic syndrome. 

Metabolic syndrome is defined as having 3 or more of the following features:

• Obesity
• Diabetes
• Low HDL cholesterol (low levels of good cholesterol)
• High lipids called triglycerides
• High blood pressure

Because of similar lifestyles and genetics, those with a family history of NAFLD may be at higher risk for developing the disease.

Patients with NAFLD typically have no symptoms or specific findings on physical exam. Occasionally, patients will report vague discomfort in their right upper abdomen or fatigue. 

Symptoms of a NASH may include fatigue, difficulty concentrating, itchy skin, abdominal discomfort on the right side, and low energy. 

Diagnosis is not always simple because patients usually have no symptoms and liver tests can be completely normal. Diagnosis is typically made if testing for other causes of liver disease is negative and there are findings of fat deposition on imaging tests (like ultrasound, CAT scan or MRI).

 Noninvasive tests, like Fibroscan (transient elastography) and newer MRI imaging can also estimate the amount of fat and scar tissue in the liver.

Active research is ongoing, but for now there are no FDA approved medications specifically for the treatment of NAFLD/NASH. However, studies have shown that both fat, inflammation and scar tissue can leave your liver. This means that NAFLD and NASH can be reversible.

Improving liver fat and inflammation is possible when people lose weight and/or modify their lifestyle. This is the first line treatment for NAFLD/NASH.

• Lifestyle modification includes adopting a MEDITERRANEAN (MED) diet as well as increasing physical activity.
• Losing 10% of your total current body weight increases the likelihood that the amount of liver fat and inflammation will improve. Weight loss should be gradual (a goal of 1-3 pounds per week), as rapid weight loss can actually worsen liver disease.
• Improving other metabolic diseases such as diabetes, high blood pressure and high cholesterol/lipids can also help NAFLD