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FAQ on Non-Alcoholic Fatty Liver Disease (NAFLD)

By Dr. Sanjiv Saigal in Liver Transplant and Biliary Sciences

Aug 26 , 2021 | 4 min read

Q1- What is NAFLD?

Non-alcoholic fatty liver disease (NAFLD) occurs due to accumulation of excess fat in the liver, usually more than 5% of liver weight. It is usually seen in people who are overweight or obese. However, it has also been observed in people wo are not obese, which is referred to as lean NAFLD. A healthy liver should contain little or no fat.

Early-stage NAFLD does not usually cause any harm, but it can lead to serious liver damage, including liver cirrhosis, if it gets worse.

Q2. What are the risk factors for NAFLD?

You are at risk for getting NAFLD if you have associated conditions such as Obesity, Diabetes, Hypertension, Dyslipidemia. These factors are a part of metabolic syndrome. NAFLD also increases your chance of developing heart problems. Insulin resistance is a key pathogenic factor in both NAFLD and metabolic syndrome. Available data from clinical, experimental and epidemiological studies indicate that NAFLD may be the hepatic manifestatiosn of metabolic syndrome

Q3- How is it different from ALD?

Alcoholic fatty liver is seen in those who consume alcohol. The fatty degeneration of liver cells occurs to a greater degree in NAFLD than in ALD. ALD patients more often present at advanced stage compared to NAFLD. NAFLD patients are more likely to have associated conditions like diabetes, hypertsion, dyslipidemia and obesity.

Q4- What is the disease burden of NAFLD in India?

Epidemiological studies suggest prevalence of NAFLD in around 9% to 32% of general population in India with higher prevalence in those with overweight or obesity and those with diabetes or prediabetes.

Clinicopathological studies show that NAFLD is an important cause of unexplained rise in hepatic transaminases, cryptogenic cirrhosis and cryptogenic hepatocellular carcinoma in Indian patients. There is high prevalence of insulin resistance and nearly half of Indian patients with NAFLD have evidence of full-blown metabolic syndrome.

Q5- Is it a problem only in adults or even in children?

NAFLD can affect people of any age, including children. This is more commonly being seen in India due to the changing lifestyle among school going children wherein they spend less time in outdoor activities, coupled with bad eating habits.

Q6- Is simple fatty liver a matter of concern ?

In most cases, fatty liver disease does not cause any serious problems or prevent your liver from functioning normally. But in up to one third of patients, it can get worse over time.

It progresses through three stages:

Your liver becomes inflamed (swollen), which damages its tissue. This stage is called Non-alcoholic steatohepatitis (NASH).
Scar tissue forms where your liver is damaged. This process is called fibrosis.
Extensive scar tissue replaces healthy tissue, leading to cirrhosis of liver.

Distinguishing between simple fatty liver and NASH is important. Why? Because for most people, having simple fatty liver doesn’t cause sickness related to the liver, whereas those with NASH have inflammation and injury to their liver cells.

Q7- How do you diagnose?

In most cases, NAFLD is asymptomatic in the early stages, and it is picked up upon routing health screening tests. You probably will not know you have it unless it's diagnosed during tests carried out for another reason.

Occasionally, people with NASH or fibrosis (more advanced stages of NAFLD) may experience:

a dull or aching pain in the top right of the tummy (over the lower right side of the ribs)
tiredness, fatigue and weakness

If cirrhosis (the most advanced stage) develops, you can get more severe liver cirrhosis symptoms, such as yellowing of the skin and eyes (jaundice), itchy skin, and swelling in the legs, ankles, feet or tummy (oedema).

NAFLD is often diagnosed after a blood test called a liver function test produces an abnormal result and other liver conditions, such as hepatitis, are ruled out.

The condition may also be diagnosed during an ultrasound scan of your tummy.

If you're diagnosed with NAFLD, further tests may be needed to determine which disease stage you have. This may involve a special blood test or having another type of ultrasound scan (Fibroscan).

A small fraction of patients may need a liver biopsy, where a small sample of liver tissue is taken using a needle so it can be analysed in a laboratory.

Q8- What are the treatment options for managing NAFLD?

Lifestyle modifications, diet, exercise and weight reduction remains the cornerstone in managing NAFLD.

There is currently no specific medication for NAFLD but making healthy lifestyle choices can help. However, several drugs are in pipeline for its treatment, the most commonly used being Vitamin E.

Treatment also may be recommended for associated conditions (high blood pressure, diabetes and cholesterol) or complications.

MYTHS:

NAFLD happens only in fat people. (No, it can also affect non-obese persons, which is called lean-NAFLD).
It is a disease of west. (No, it is being increasingly seen in developing nations such as India due to the changing lifestyle).
NAFLD is a benign disease. (No it can cause serious liver damage over a period of time leading to liver cirrhosis).

FACTS:

NAFLD burden is increasing in India. It needs public attention and prioritized by public health sector to promote healthy food habits and physical activity.
NAFLD can not only cause fatty liver disease but can also cause steatohepatitis, cirrhosis and cancer.

Lifestyle modification, diet and exercise are the most important aspects in treating NAFLD.