What is non-alcoholic fatty liver disease (NAFLD)?
NAFLD is a liver disease characterized by fat deposition in the liver. It has a spectrum of severity based on liver biopsy appearance and symptoms.
Is NAFLD common?
Yes. When using ultrasound alone for detection, its prevalence approaches 50% of primary care patients. Only a percentage of these go on to have progressive liver disease.
Why do people get NAFLD?
NAFLD commonly occurs in association with some or all of the components of the metabolic syndrome (1. Central obesity 2. Hypertension 3. Diabetes or glucose intolerance 4. Low HDL/High LDL). It is felt that diet and lifestyle choices over years play a contributing role to its development and evolution.
What is NASH?
NASH is an acronym for Non-Alcoholic Steatohepatitis. It is the most severe form of NAFLD and is often progressive, resulting in cirrhosis and its complications. Its microscopic appearance is virtually indistinguishable from alcoholic liver disease, and differentiation requires a detailed history.
Are there any risk factors for developing more severe NAFLD or NASH?
Body mass index (BMI), diabetes, level of liver enzymes, and Hispanic race
Do all patients with NAFLD need a liver biopsy?
No. Labs and ultrasound can usually determine if a patient has fatty liver disease. Liver biopsy can diagnosis NASH, which is important particularly in younger patients. Identifying NASH is important because it places patients in a higher risk subgroup and justifies more aggressive treatment strategy.
Are there any treatments?
Treatment primarily centers on lifestyle modifications, particularly related to caloric consumption and exercise/energy expenditure. High fructose corn syrup consumption and fast food intake have both been linked to NAFLD. A rigorous program of caloric restriction to 1500 kcal daily and 200 minutes of low impact exercise/week resulted in regression of NASH on liver biopsy.
What about medications?
No medications have been proven to universally work in NAFLD. Some studies suggest benefit of vitamin E, but this should only be used under the direction of a provider familiar with NAFLD.