Description

Non-alcoholic fatty liver, often called non-alcoholic fatty liver is a liver problem that affects people who drink little or no alcohol. In the non-alcoholic fatty liver, excess fat accumulates in the liver. It is most often seen in people who are overweight or obese.

The nonalcoholic fatty liver disease is increasingly common, particularly in the Middle East and the Western countries such as the number of people with obesity increases. It is the most common form of liver disease in the world. Nafld ranges in severity of hepatic steatosis, called fatty liver, to a more severe form of the disease called non-alcoholic steatohepatitis (NASH).

NASH causes the liver to swell and become damaged due to deposits of fat in the liver. NASH can get worse and may lead to serious scarring in the liver, called cirrhosis, and even liver cancer. This damage is like the damage caused by the excessive use of alcohol.

The movement is currently underway to change the name of non-alcoholic fatty liver to the metabolic dysfunction associated with the steatotic liver disease (MASLD). Also, the experts have recommended changing the name of non-alcoholic steatohepatitis to the metabolic dysfunction associated with non-alcoholic steatohepatitis (MASH).

Symptoms

Nafld often has no symptoms. When it does, they may include:

  • Fatigue.
  • You do not feel well, or discomfort.
  • Pain or discomfort in the upper right part of the belly area.

The possible symptoms of NASH and cirrhosis, or severe scarring, which include:

  • Itching in the skin.
  • Abdominal swelling, also called ascites (uh-SY-teez).
  • Shortness of breath.
  • Swelling of the legs.
  • Spider-like blood vessels just below the surface of the skin.
  • Enlargement of the spleen.
  • Red palms.
  • Yellowing of the skin and of the eyes, or icterus.

When to see a doctor

Make an appointment with a member of your health care team if you have lasting symptoms that worry you.

Causes

The experts don't know exactly why fat accumulates in some livers and others do not. Also do not fully understand why some fatty livers are converted into NASH .

NAFLD and NASH are both linked to the following:

  • Genetics.
  • Being overweight or obese.
  • Insulin resistance, which occurs when the cells can't take sugar in response to the hormone insulin.
  • Type 2 diabetes, sometimes called high blood sugar or hyperglycemia.
  • The high levels of fat, especially triglycerides, in the blood.

The combination of these health problems can contribute to a fatty liver. However, some people suffer from non-alcoholic fatty liver, even if they do not have any risk factor.

Risk factors

Many diseases and health problems can increase your risk of nonalcoholic fatty liver disease , including:

  • The family history of the disease of fatty liver or obesity.
  • Growth hormone deficiency, which means that the body doesn't make enough hormones to grow.
  • High cholesterol.
  • High levels of triglycerides in the blood.
  • The insulin resistance.
  • The metabolic syndrome.
  • Obesity, especially when fat is focused on the waist.
  • The polycystic ovary syndrome.
  • Obstructive sleep apnea.
  • Type 2 diabetes.
  • Underactive thyroid, also called hypothyroidism.
  • Hypofunction of the pituitary gland, or hypopituitarism.

NASH is more likely in these groups:

  • People over the age of 50 years.
  • People with certain genetic risk factors.
  • People with obesity.
  • People with diabetes or high blood sugar.
  • People with symptoms of metabolic syndrome, such as high blood pressure, high triglyceride levels and a large size of the waist.

It is difficult to differentiate NAFLD from NASH without a clinical evaluation and testing.

Complications

The severe scarring of the liver or cirrhosis, is the main complication of NAFLD and NASH . Cirrhosis occurs due to the lesion in the liver, such as the damage caused by the inflammation of NASH . As the liver tries to stop the inflammation, creates areas of scarring, also called fibrosis. With the course of inflammation, fibrosis, spreads and occupies most of the liver tissue.

If nothing is done to stop the scarring, cirrhosis can lead to:

  • The accumulation of fluid in the area of the stomach, called ascites.
  • Swollen veins in the esophagus, or esophageal varices, which may break and bleed.
  • Confusion, drowsiness and slurred speech, also called hepatic encephalopathy.
  • Overactive spleen, or hypersplenism, which can lead to too few platelets in the blood.
  • Cancer of the liver.
  • In the final stage of liver failure, which means that the liver has stopped working.

Experts guess that about 24% of adults in the US have non-alcoholic fatty liver , and around 1.5% to 6.5% have NASH .

Prevention

To reduce the risk of non-alcoholic fatty liver :

  • Eat a healthy diet. Eating a healthy diet that is rich in fruits, vegetables, whole grains, and healthy fats.
  • Limit the consumption of alcohol, simple sugars, and the sizes of the portions. Avoid sugary drinks such as soda, sports drinks, juice and sweet tea. Drinking alcohol can damage the liver and should be avoided or minimized.
  • Maintain a healthy weight. If you are overweight or obese, work with your health care team to gradually lose weight. If you are at a healthy weight, work to maintain it by eating a healthy diet and exercise.
  • Exercise. Be active on most days of the week. Your health care team if you have not been exercising regularly.

Diagnosis

Due to the non-alcoholic fatty liver usually does not cause symptoms, it is often found when the tests done for other reasons point to a liver problem. For example, a blood test during an annual exam may show elevated levels of liver enzymes, which can lead to more tests and a diagnosis of non-alcoholic fatty liver.

Tests for the diagnosis of nonalcoholic fatty liver disease , to rule out other diseases and see how bad damage to the liver include:

Blood tests

  • Complete blood count.
  • Iron studies, which show how the amount of iron in your blood and other cells.
  • The liver enzyme and liver function tests.
  • Tests for chronic viral hepatitis (hepatitis a, hepatitis C, and others).
  • Celiac disease screening test.
  • Fasting blood sugar.
  • The hemoglobin A1C test, which shows how stable your blood sugar level.
  • The lipid profile, which measures blood fats, including cholesterol and triglycerides.

Imaging procedures

Images of diagnostic tests of non-alcoholic fatty liver include:

  • The Abdominal ultrasound, which is often the first test that is used when the liver disease is suspected.
  • Magnetic resonance imaging (MRI) or computed tomography (CT). These tests are better at finding mild liver fibrosis, but cannot tell NASH from nafld .
  • Transient elastography, a new type of ultrasound that measures the stiffness of your liver. The stiffness of the liver is a sign of fibrosis or scarring.
  • Magnetic resonance elastography, which combines magnetic resonance imaging with sound waves to create a visual map, or elastogram, showing the stiffness of the tissues of the body.

Liver biopsy

If other tests show signs of advanced liver disease or NASH , or if the results are not clear, your doctor may suggest a biopsy of the liver. The liver biopsy is a procedure to remove a small piece of tissue from the liver. It is usually performed by using a needle through the abdominal wall. The tissue sample is examined in a laboratory for signs of inflammation and scarring. Liver biopsy is the best way to diagnose NASH and clearly shows the amount of damage to the liver.

A liver biopsy can be uncomfortable, and has no risk of your health care team will go more in detail with you. This procedure is performed by using a needle that is passed through the abdominal wall and in the liver.

Treatment

The treatment for nonalcoholic fatty liver disease usually begins with loss of weight. This can be done by eating a healthy diet, limiting the size of the portions and exercise. The loss of weight can improve other health problems that cause non-alcoholic fatty liver. Normally, the loss of 10% of their body weight or more is recommended. But the low of 3% to 5% of your starting weight can have benefits. Weight-loss surgery or medications can also be helpful for certain people.

A new drug to treat people who have NASH with moderate-to-severe scarring of the liver. Resmetirom (Rezdiffra) can help you to reduce the amount of fat that builds up in the liver. This medicine is not recommended for people with cirrhosis. For those who have cirrhosis due to NASH, a liver transplant may be necessary.

Lifestyle and home remedies

With the help of your health care team, you can take steps to control the disease non-alcoholic fatty liver. You can:

  • To lose weight. If you are overweight or obese, reduce the number of calories you eat each day and increase your physical activity to lose weight slowly. Eating fewer calories is the key to losing weight and managing this disease. If you've tried to lose weight in the past and could not, ask your health care team for help.
  • Choose a healthy diet. Eating a healthy diet that is rich in fruits, vegetables and whole grains. Your health care team can suggest avoiding or limiting certain foods and drinks, such as white bread, processed and red meat, juices and sugary drinks. Keep track of all the calories that you ingest.
  • Exercise and be more active. Try to do at least 150 minutes of exercise a week. If you are trying to lose weight, you might find that more exercise is helpful. But if you don't already exercise regularly, get your health care team of the first to ACCEPT and start slowly.
  • Manage your diabetes. Follow your healthcare team's advice for managing your diabetes. Take your medicines as advised by your care team and watch your blood sugar closely.
  • Lower cholesterol and blood pressure. Improve cholesterol levels and blood pressure if they are high. A healthy diet, exercise and medication can help to maintain cholesterol, triglycerides, and blood pressure at healthy levels.
  • Protect the liver. Avoid things that could harm your liver health. For example, do not drink alcohol. Follow the instructions that appear in all of the medicines and drugs you can buy without a prescription. Check with your health care team before using herbal supplements, since some may damage the liver.

Alternative medicine

There is No alternative medicine treatments have been shown to cure non-alcoholic fatty liver. But researchers are studying whether some supplements or natural compounds could be useful, such as:

  • Vitamin E. In theory, vitamin E and other vitamins called antioxidants may help protect the liver by reducing or canceling out the damage caused by inflammation. But more research is needed. Some evidence suggests that vitamin E supplements can be helpful for people withNAFLDwho not have type 2 diabetes. Supplements of vitamin E is not recommended for people with severe scarring of the liver or type 2 diabetes. Vitamin E has been linked with a slight increase in the risk of heart disease and prostate cancer.
  • Coffee with caffeine.Some studies suggest that coffee may be beneficial for the liver, reducing the risk of diseases of the liver likeNAFLDand the reduction of the likelihood of healing. It is not yet clear how coffee can prevent damage to the liver. But certain compounds in coffee is thought to decrease inflammation and slow scar tissue growth. If you already drink coffee, these results may make you feel better about your morning cup. But if you don't drink coffee, this is probably not a good reason to start. Discuss the possible benefits of coffee with your health care team.

Vitamin E. In theory, vitamin E and other vitamins called antioxidants may help protect the liver by reducing or canceling out the damage caused by inflammation. But more research is needed.

Some evidence suggests that supplements of vitamin E can be helpful for people with non-alcoholic fatty liver that do not have type 2 diabetes. Supplements of vitamin E is not recommended for people with severe scarring of the liver or type 2 diabetes. Vitamin E has been linked with a slight increase in the risk of heart disease and prostate cancer.

Coffee with caffeine. Some studies suggest that coffee may be beneficial for the liver, reducing the risk of diseases of the liver, such as non-alcoholic fatty liver and the reduction of the likelihood of healing. It is not yet clear how coffee can prevent damage to the liver. But certain compounds in coffee is thought to decrease inflammation and slow scar tissue growth.

If you already drink coffee, these results may make you feel better about your morning cup. But if you don't drink coffee, this is probably not a good reason to start. Discuss the possible benefits of coffee with your health care team.

Preparing for your appointment

Consult your family doctor or primary healthcare provider if you have symptoms that concern you. If your doctor suspects a problem with the liver, such as non-alcoholic fatty liver, you may be referred to a doctor who specializes in the liver, called a hepatologist.

Because appointments can be brief, it is a good idea to be well prepared. Here are some tips to help you prepare, and what to expect from your doctor.

What you can do

  • Knowing what to do prior to your visit. When you make the appointment, ask if there is something that you need to do beforehand.
  • Write down the symptoms you are experiencing, including any that seem unrelated to the appointment.
  • Make a list of all medications, vitamins or supplements you are taking.
  • Take any relevant medical records, such as records of the tests that I have had that relate to your current condition.
  • Have a friend or family member, if possible. Sometimes it can be difficult to remember all information that is obtained during an appointment. Someone who comes with you may remember something that you missed or forgot.
  • Write questions to ask their health care team.

If you have fatty liver disease, non-alcoholic, some basic questions to ask include:

  • Is fat in the liver harming my health?
  • My fatty liver disease has become serious?
  • What are my treatment options?
  • What can I do to keep my liver healthy?
  • I have other health problems. How can I best manage them together?
  • You should see a specialist? Will my insurance cover it?
  • Are there brochures or other printed material that I can take with me? What sites do you recommend?
  • Should I plan for a follow-up visit?

In addition to the questions that you've prepared to ask your care team, do not hesitate to ask questions during your appointment.

What to expect from your doctor

Your doctor may ask you a series of questions, such as:

  • Have you had symptoms, such as yellowing of the eyes or skin, and the pain, or swelling around your waist?
  • If you had tests done at that time, what were the results?
  • Do you drink alcohol?
  • What do the medicines you take, including over-the-counter medicines and supplements?
  • Have you ever been told that you have hepatitis?
  • Do other people in your family have a disease of the liver?
Symptoms and treatment of liver disease, Non-alcoholic fatty