What Are The Causes of Non-Alcoholic Fatty Liver Disease (NAFLD)?

Usually seen in people who are overweight or obese, non-alcoholic fatty liver disease (NAFLD) covers a range of conditions caused by a build-up of fat in the liver. Early stages of the disease do not usually cause any harm, however liver damage may occur if it gets worse. Having high levels of fat in your liver is also associated with an increased risk of serious health problems, such as diabetes, high blood pressure and kidney disease.

Illustration of non-alcoholic fatty liver disease. For comparison shows the healthy and diseased liver

Risk factors for NAFLD include:

  • Obesity, particularly if you have a lot of fat around your waist
  • Type 2 diabetes mellitus
  • Insulin resistance, such as in polycystic ovary syndrome
  • An underactive thyroid
  • High blood pressure
  • High cholesterol levels
  • Metabolic syndrome (a combination of diabetes, high blood pressure and obesity)
  • People over the age of 50
  • Smoking

Stages of NAFLD:

  1. Simple fatty liver (steatosis) – a largely harmless build-up of fat in the liver cells. Most people will only ever develop the first stage, usually without realizing it.
  2. Non-alcoholic steatohepatitis (NASH) – a more serious form of NAFLD, where the liver cells have become inflamed.
  3. Liver fibrosis – where persistent inflammation leads to the development of scar tissue around the liver and surrounding blood vessels. At this point, the liver is still able to function normally.
  4. Liver cirrhosis – the most severe stage, occurring after years of inflammation, where the liver shrinks and becomes scarred and lumpy; this damage is permanent and can lead to liver failure (where your liver stops working properly) and also liver cancer.

If detected and managed at an early stage, it’s possible to stop NAFLD from getting worse by reducing the amount of fat in your liver. It can take years for fibrosis or cirrhosis to develop, hence the importance of making lifestyle changes to prevent the condition from worsening.

There are usually no symptoms of NAFLD in the early stages. You will probably discover the disease is present while undergoing a routine health check by doing blood tests. 

Occasionally, people with NASH or liver fibrosis may experience the following symptoms:

  • Dull or aching pain at the top right part of your abdomen (beneath the ribs)
  • Extreme fatigue
  • Unexplained weight loss
  • Generalized weakness

In liver cirrhosis (the most advanced stage of the disease) the symptoms are more severe:

  • Jaundice (yellowing of the skin and whites of the eyes)
  • Itching of the skin
  • Swelling in the legs, ankles, feet or tummy (also known as oedema)

How is NAFLD diagnosed?

This liver condition is often picked up by doctors after a blood test called a liver function test produces an abnormal result and other liver conditions, such as hepatitis, are ruled out. It may also be spotted during an ultrasound scan of your abdomen. However, the best imaging modality to detect NAFLD is computed tomographic scanning (CT scan) and magnetic resonance tomography (MRT). Some people may also need to undergo a liver biopsy.

Treatment for NAFLD

Making healthy lifestyle choices can help. Treatment may also be recommended for associated conditions (high blood pressure, diabetes and cholesterol) to prevent complications. 

A local study funded by the University of Malaya Research Grant has found that high doses of milk thistle (Silybum marinum) extract result in significantly greater liver fibrosis improvement. Patients are also advised to have regular appointments with their doctor to monitor the liver function tests and look for symptoms or signs of any new problems.

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