Treating fatty liver disease requires lifestyle changes

By Mary Beth Lemley

Grillo Information Center

Q: I know a few people who have been diagnosed with non-alcoholic fatty liver disease. What is it and how is it treated?

A: Non-alcoholic fatty liver disease is the buildup of extra fat in liver cells that is not caused by drinking alcohol. Excessive alcohol consumption is a common cause of fatty liver disease, so the term NAFLD is reserved for cases not associated with alcohol.

There are two phases of NAFLD: non-alcoholic fatty liver disease and non-alcoholic steatohepatitis. NAFL is characterized by excess fat in the liver but little or no inflammation or damage to the liver. Most people with this disease have no symptoms. But in a small subset of people with NAFL, the disease progresses to NASH, which is defined by inflammation and damage to the liver. At this stage, some people experience symptoms such as pain and swelling in the upper right abdomen.

The risk of developing NAFLD is higher in people who are obese, diabetic or prediabetic, or have high blood pressure. This condition is most commonly found in Hispanics, followed by non-Hispanic whites and Asian Americans. NAFLD occurs in children, but is most commonly seen in middle age. In the United States, 10-20% of the population has NAFL and 2-5% has NASH.

The cause of NAFLD is unknown. Metabolic syndrome (a group of metabolic disorders), high fructose diets, and genetic factors are all being studied to find out how they might be involved in causing this condition.

When liver function tests show high levels of liver enzymes in the blood, NAFLD may be suspected. Imaging tests such as ultrasound, MRI, or CT scan may be used to better see the liver. The diagnosis is ultimately based on a liver biopsy.

Complications of NAFLD appear when NASH progresses to even more severe liver damage called cirrhosis. This is a permanent scarring of the liver which can eventually lead to liver failure.

There are currently no drugs approved to treat NAFLD, but many are being studied. The current treatment strategy is to follow a healthy diet to maintain a reasonable weight, control blood pressure, control blood sugar, and manage cholesterol and blood lipid levels. These lifestyle measures can slow, stop, or even reverse NAFLD.

Working with a healthcare provider to achieve these goals improves the outlook and prognosis for NAFLD. All medications (prescription drugs and over-the-counter products) and nutritional or herbal supplements should be reviewed because they can affect liver function and complicate NAFLD.

Mary Beth Lemley is a volunteer at the Grillo Center, which offers free, confidential research to help with health understanding and decisions. To use this service, contact the center at or 303-415-7293. No research or assistance should be construed as medical advice. We encourage informed consultation with a healthcare professional.

where to find it

American Liver Foundation

Google: nfld liver foundation

Johns Hopkins Medicine

Google: Johns Hopkins nfld

National Institute of Diabetes and Digestive and Kidney Diseases

Google: NIDDK nfld

Cleveland Clinic

Google: cleveland clinic nafld health library

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