Fatty Liver Disease

Nonalcoholic Fatty Liver Disease

Nonalcoholic Fatty Liver Disease (NAFLD) is a condition caused by a buildup of excess fat in the liver that is not due to alcohol abuse. As the name suggests, the distinction is made because most cases in which fat accumulates in the liver are caused by alcohol abuse — a condition called “alcohol-associated liver disease.”

NAFLD can occur in those who drink in moderation or don’t drink at all. The condition can even occur in children.

There are two types of Nonalcoholic Fatty Liver Disease:

  • Nonalcoholic Fatty Liver (NAFL), a condition in which you have fat in your liver but no liver damage due to inflammation. NAFL usually doesn’t cause liver damage, but can cause pain due to an enlarged liver
  • Nonalcoholic Steatohepatitis (NASH), a condition which involves fat in the liver that causes inflammation and liver damage. NASH can cause scarring (AKA fibrosis) of the liver, which can lead to cirrhosis, a condition in which the liver is scarred and permanently damaged.

Nonalcoholic Fatty Liver Disease is more common in people with obesity and conditions associated with being overweight, including type 2 diabetes. According to the National Institutes of Health, between one-third and two-thirds of people with type 2 diabetes are thought to have NAFLD, along with up to 75% of those who are overweight and over 90% of those who are obese. In some cases, overweight or obese people with NASH who lose weight can cause their condition to switch to NAFL, which usually doesn’t cause liver damage.

According to the NIH, around 24% of adults in the U.S. are estimated to have NAFLD, making it one of the most common causes of liver disease in the U.S. Because NAFLD is a condition that often displays few to no noticeable symptoms, people who have liver damage due to the disease may not know they have it.

Why Hoag for Nonalcoholic Fatty Liver Disease Treatment?

Diagnosed with Nonalcoholic Fatty Liver Disease, or have symptoms that make you worried you might? As Orange County’s leader in comprehensive care for serious disorders of the liver, Hoag Digestive Health Institute is your best choice for diagnosis, treatment and a more complete recovery.

Hoag’s comprehensive Liver Program offers advanced treatment for serious liver disorders, including NAFLD and NASH. From diagnosis to recovery, we offer next-generation imaging and treatment options that can make all the difference in your level of care.

Because NAFLD often strikes those who are overweight, Hoag delivers a one-two punch to this challenging disease with Southern California’s best programs for weight loss, helping patients find a personalized and achievable pathway to health with lasting results. That includes Hoag’s multidisciplinary Bariatric Surgery Weight Loss Program, which takes a holistic and individualized approach to bariatric care.

Symptoms & Causes of Nonalcoholic Fatty Liver Disease

While many of those who are overweight or obese may have nonalcoholic fatty liver disease (NAFLD), it is a condition that often displays few outward, telltale signs. Those with Nonalcoholic Steatohepatitis (NASH), the most damaging form of NAFLD, may not know they have the disease even after developing cirrhosis, which is dangerous scarring of the liver due to inflammation.

Known symptoms of NAFLD or NASH include:

  • Pain in the upper right side of the abdomen
  • Unexplained fatigue
  • An enlarged liver
  • Symptoms of cirrhosis, including an enlarged spleen
Risk Factors

There are a number of factors that are believed to increase your risk of developing nonalcoholic fatty liver disease, or which are associated with the condition. These include:

  • Being overweight or obese
  • Having type 2 diabetes or insulin resistance
  • Having abnormal levels of fat in your blood, including high triglycerides, high overall cholesterol, high LDL cholesterol or low HDL cholesterol
  • Having metabolic syndrome, which are traits linked to being overweight or obese. These traits include:
    • higher-than-normal blood glucose or being diagnosed with type 2 diabetes
    • high levels of triglycerides in the blood
    • low levels of HDL cholesterol in the blood
    • high blood pressure
    • large waist size

Diagnosis & Tests for Nonalcoholic Fatty Liver Disease

The first sign of nonalcoholic fatty liver disease are often blood test results showing elevated levels of certain liver enzymes in your blood, including alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Based on these elevated levels, your doctor may order other tests, including imaging tests.

Imaging tests your doctor may recommend to help diagnose NAFLD include:

  • Ultrasound, which utilizes powerful sound waves to create images of the organs and structures inside the body
  • Computed tomography (CT) scan
  • Magnetic resonance imaging (MRI)
  • Elastography, which is an imaging that can detect the stiffness of your liver and sometimes help determine whether you have advanced liver scarring

Imaging tests can show whether you have fat in your liver, but usually cannot determine whether you have inflammation and liver scarring. As a result, imaging tests alone cannot determine whether you have Nonalcoholic Fatty Liver (NAFL) or the more damaging Nonalcoholic Steatohepatitis (NASH).

Currently, the only test that can determine whether you have NASH is a liver biopsy. During a liver biopsy, a long, thin needle is passed through the skin and into the liver to retrieve a tissue sample that can be examined in a lab. However, your doctor might only recommend you for a biopsy if you are likely to have NASH with advanced liver scarring, or if tests reveal symptoms of cirrhosis or advanced liver disease.

Management & Treatment for Nonalcoholic Fatty Liver Disease

Once a diagnosis of nonalcoholic fatty liver disease or NASH has been made, weight loss through diet, exercise and lifestyle changes is often recommended to help treat the disease and slow any ongoing damage to the liver. According to the National Institutes of Health, patients may need to lose up to 10% of their body weight to reduce inflammation and scarring in their liver. Losing weight can sometimes cause NASH to switch to the less-dangerous nonalcoholic fatty liver, which usually doesn’t cause liver inflammation and ongoing damage.

If the liver has suffered damage due to NASH at the time of diagnosis, doctors can often treat many of the complications. However, any scarring sustained by the liver is usually permanent, and can severely limit the organ’s function depending on the extent of the damage. Those who develop liver failure or liver cancer due to this type of damage may require a liver transplant.

Prevention of Nonalcoholic Fatty Liver Disease

While medicine is always looking for new preventative treatments, currently, the only way to reduce your risk of developing nonalcoholic fatty liver disease or Nonalcoholic Steatohepatitis (NASH) is to maintain a healthy weight.


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