Liver disease is commonly known to affect people who drink alcohol excessively. It can, however, also affect people who drink little or even no alcohol at all.
The umbrella term for a range of liver conditions that are not related to alcohol consumption is non-alcoholic fatty liver disease (NAFLD). The main characteristic of NAFLD is too much fat stored in liver cells.
Some people with NAFLD can develop non-alcoholic steatohepatitis (Nash). This is an aggressive form of fatty liver disease, which is marked by liver inflammation and may progress to advanced scarring called cirrhosis and liver failure.
NAFLD usually has no signs or symptoms. However, when it does, some of the symptoms may include fatigue as well as pain or discomfort in the upper right abdomen.
Some of the possible signs and symptoms of Nash and advanced scarring or cirrhosis include abdominal swelling, enlarged blood vessels just beneath the skin’s surface, enlarged spleen, red palms, larger-than-normal breasts in men and yellowing of the skin and eyes, which is also called jaundice.
Researchers have not identified exactly why some people accumulate fat in the liver while others do not. Similarly, there is limited understanding of why some fatty livers develop inflammation that progresses to cirrhosis.
NAFLD and Nash are both linked to several conditions such as being overweight or obese, insulin resistance, in which your cells do not take up sugar in response to the hormone insulin, high blood sugar indicating pre-diabetes or type 2 diabetes as well as high levels of fats, particularly triglycerides, in the blood.
Other causes may result from malnutrition, losing weight rapidly or being exposed to certain toxins and chemicals.
These combined health problems appear to promote the deposit of fat in the liver. For some people this excess fat acts as a toxin to liver cells, causing liver inflammation and NASH, which may lead to a build-up of scar tissue in the liver.
Metabolic syndrome can also cause NAFLD. This is a mix of conditions that make you more likely to develop type 2 diabetes and heart disease. With metabolic syndrome, you may have a large waist size, high triglycerides, high blood pressure and high blood sugar.
There are also some less common reasons why you may develop NAFLD or NASH. They include medical conditions that affect how your body uses or stores fat, Hepatitis C or other infections.
Taking certain medicines such as glucocorticoids, methotrexate, synthetic oestrogen, tamoxifen and others can also cause NAFLD. Some people who have surgery to remove their gallbladder are more likely to have NAFLD as well.
Diagnosing NAFLD is difficult as most people do not have symptoms. Your doctor may use different methods to find out if you have fatty liver disease.
The doctor may ask about your alcohol use. This information can help your doctor tell if you have alcoholic liver disease or NAFLD, so your answers must be truthful. You can also be asked about medications you take, how you eat and other health conditions you might have.
A physical examination may be carried out that may include checking your weight and looking for signs of liver problems such as an enlarged liver or jaundice.
Blood tests can be done to show if you have high levels of liver enzymes such as alanine aminotransferase (ALT) and aspartate aminotransferase (AST). If they are high, there could be a problem with your liver.
You may also have an ultrasound computerised tomography (CT) scan or magnetic resonance imaging (MRI). These tests can help show if there is any fat in your liver.
A liver biopsy may also be done. Not everyone with NAFLD needs to have a liver biopsy. Your doctor may recommend it if you are at risk of NASH or if other tests show that you may have NASH complications such as cirrhosis.
Risks involved with NAFLD
NAFLD increases the risk of a wide range of diseases and conditions. These include high cholesterol, high levels of triglycerides in the blood, metabolic syndrome and obesity, particularly when fat is concentrated in the abdomen.
Other conditions include polycystic ovary syndrome, sleep apnoea, type 2 diabetes, hypothyroidism and hypopituitarism.
Nash is more likely to affect older people, anyone with diabetes and people with body fat concentrated in the abdomen.
The main complication of NAFLD and Nash is cirrhosis, which is late-stage scarring in the liver. Cirrhosis occurs in response to liver injury, such as the inflammation in Nash. As the liver tries to halt inflammation, it produces areas of scarring called fibrosis. With continued inflammation, fibrosis spreads to take up more and more liver tissue.
If the process is not interrupted, cirrhosis can lead to liver cancer, fluid build-up in the abdomen, swelling of veins in your oesophagus that can rupture and bleed, confusion, drowsiness and slurred speech.
Cirrhosis can also cause end-stage liver failure, which means the liver will stop functioning completely.
There are no medications approved for NAFLD yet. Usually the first line of treatment is to lose weight. It helps reduce fat, inflammation and scarring in your liver. Losing just three to five percent of your body weight can cut down on how much fat is in your liver.
You will also need to quit drinking. It is the only way you can keep liver damage from becoming worse. You may even be able to undo some of the liver damage that has already happened.
If you have complications due to Nash, such as cirrhosis or liver failure, you may need to have a liver transplant.
To reduce your risk of NAFLD and Nash, choose a healthy diet that is plant-based, rich in fruits, vegetables, whole grains and healthy fats.
Maintain a healthy weight. If you are overweight or obese, reduce the number of calories you eat each day and get more exercise. If you have a healthy weight, work to maintain it by choosing a healthy diet and exercising. Make an effort to be active at least 30 minutes a day most days of the week.
Avoid doing things that will make your liver work harder. Take medications and over-the-counter drugs only as instructed. Manage your diabetes. Check your blood sugar and take prescription medications as your doctor prescribes.
- The information in this article is provided as a public service by the Cimas iGo Wellness programme, which is designed to promote good health. It is provided for general information only and should not be construed as medical advice. Readers should consult their doctor or clinic on any matter related to their health or the treatment of any health problem. — firstname.lastname@example.org or WhatsApp 0772 161 829 or phone 024-2773 0663