Nonalcoholic Fatty Liver Disease

Nonalcoholic fatty liver disease (NAFLD) describes a condition in which the liver stores excess fat but is not secondary to alcohol, a virus, drugs, metabolic disorders, syndromes and other factors that may affect the liver’s ability to metabolize or export fat. NAFLD is currently the most common cause of abnormal liver blood tests in the United States.

The disease process is usually associated with obesity, abnormal lipid levels (high cholesterol), diabetes, and prediabetes. Severity of NAFLD can range from fat storage in the liver, fat and inflammation in the liver (called NASH or nonalcoholic steatohepatitis), fat and inflammation with a lot of scar tissue in the liver (cirrhosis due to NASH).

Listen to a BlogTalkRadio program about nonalcoholic fatty liver disease featuring Dr. Julia Wattacheril, from the Division of Digestive and Liver Diseases and Dr. Joel Lavine, Chief of Gastroenterology, Hepatology and Nutrition at MSCHONY.

Numerous clinical trials for NASH and NAFLD are ongoing at NewYork-Presbyterian/Columbia.  If you are interested in learning more about clinical trials offered at our center, please see here.

Causes of NAFLD

NAFLD can be understood as excess energy storage in the form of fat within the liver.  When the balance between energy going out is less than energy coming in (food), the liver may store excess energy in the form of fat. We usually see fat storage under the skin, but organs can store fat as well; when it reaches abnormal amounts, there can be consequences to this storage. These consequences can include associated metabolic disturbances, including prediabetes and diabetes.

Signs & Symptoms

NAFLD without cirrhosis is regarded as a clinically silent disease (does not have symptoms). Some patients report some general abdominal symptoms that may or may not be related to liver changes.

Risk Factors

The disease process is usually associated with obesity, abnormal lipid levels (high cholesterol), diabetes, high blood pressure, prediabetes, and metabolic syndrome.

Certain demographic factors have also been associated with increasing NAFLD risk, including age, male sex and Hispanic ethnicity.

Am I obese or overweight?

Prevention & Screening

To prevent NAFLD, and more importantly to prevent the development of diabetes and heart disease if not already present, the key for most individuals is maintaining a healthy weight through a heart healthy diet (low fat, low cholesterol, low salt), limiting simple sugars, and exercising regularly. Increasing the duration and frequency of exercise to match calorie intake will help maintain weight, and further increases will help lose weight.

If you are overweight or obese, screening by your doctor may include liver biochemistries (blood tests) and an ultrasound.

If there is concern that you may have the inflammatory form of NAFLD, or NASH, a liver biopsy will be necessary.

If you have cirrhosis due to NASH, your doctor will talk to you about appropriate screening tests.

Diagnosis

The diagnosis of NAFLD requires the presence of fat in the liver as seen by imaging studies or histology (obtained via a biopsy, or small piece of the liver) and the exclusion of other causes of fat accumulation. Many things can disrupt the liver’s metabolic activity and it is important to exclude those things as the treatment depends on the underlying cause of the problem. Currently the only way to distinguish between non-NASH NAFLD and NASH is a liver biopsy, however several risk calculators and biomarkers have been devised to help determine whether a biopsy is needed.

Treatments

The mainstay of treatment for NAFLD and NASH are lifestyle changes: weight loss, exercise and following a healthy diet. These treatments not only target the liver, but reduce overall cardiovascular risk, since cardiovascular complications are strongly associated with NAFLD. In people who have biopsy evidence of NASH (and who do not have cirrhosis or diabetes), current recommendations include vitamin E. This is not a general recommendation that should be started without consulting a physician since risks can be associated with it. Many other treatments for NASH are being developed and may be available in the near future.

Although bariatric (weight loss) surgery can improve NAFLD and NASH, it is not recommended for those diagnoses alone at this time. Patients undergoing bariatric surgery frequently do not know they have liver disease. If a person has other indications for bariatric surgery and evidence of liver disease, then bariatric surgery may be performed but should be done with the consultation of a liver specialist.

Clinical Trials/Research »

Management of Fatty Liver Disease in Children

Fatty liver disease is now recognized as the most common cause of liver disease among children in the United States. If left undetected and untreated, fatty liver disease can lead to significant liver injury. To more effectively manage patients with this condition and to meet demand for referrals, a dedicated clinic has been established at Morgan Stanley Children's Hospital for the study and management of children identified with this disease.

Our site is a member of the NASH (Nonalcoholic Steatohepatitis) Clinical Research Network, which is funded by the National Institutes of Health (NIH) with the goal of better understanding and treating fatty liver disease. Patients seen in our clinic have the opportunity to enroll in observational and treatment studies.

Learn more about our center’s treatment of children with pediatric liver disease here.

NAFLD FAQs

What diet should I follow if I have nonalcoholic fatty liver disease?

If you have nonalcoholic fatty liver disease (NAFLD), your doctor may recommend a diet low in fat and cholesterol, salt, high-fructose corn syrup, and sugar. Your doctor may also recommend reducing your overall calorie intake and increasing your consumption of vegetables, some fruits, and whole-grain foods.

NAFLD is a condition in which fat accumulates in the liver in people who drink little or no alcohol. Eating a healthy diet and exercising regularly may improve the condition of your liver as well as your health overall.

Can losing weight reduce the amount of fat in my liver?

Losing weight can help to reduce the amount of fat in your liver, as well as in other tissues of your body. Obesity is a risk factor for nonalcoholic fatty liver disease (NAFLD), a condition in which fat accumulates in liver tissue in people who drink little or no alcohol. Research indicates that people who lose even 5% to 10% of their total body weight (up to 30 pounds in a 300-pound person) improve the condition of their liver and also reduce their risk of other obesity-related health problems such as high blood pressure, heart disease and diabetes.

Can you develop liver disease if you don't drink alcohol?

Although drinking alcohol excessively can cause liver disease and damage, you can develop liver disease even if you don't drink alcohol. Two common types of liver disease in addition to alcoholic and viral liver diseases include nonalcoholic fatty liver disease (NAFLD) and a special type of NAFLD called nonalcoholic steatohepatitis, or NASH. NAFLD is a condition in which the liver contains excessive amounts of fat. People who have NASH have excessive amounts of fat in their liver with inflammation and potentially scarring of liver tissue. Any form of liver disease can be made worse by drinking alcohol.

Additional questions and answers about NAFLD may be found at http://www.sharecare.com/user/dr-julia-wattacheril/answers