Non-alcoholic fatty liver disease (NAFLD)

Non-alcoholic fatty liver (NAFLD) is a condition where fat builds up in the cells of your liver. It’s very common, but most people only have a mild form, which doesn’t usually cause long-term problems. However, some people with NAFLD can go on to develop more serious liver damage.

Unlike alcohol-related liver disease, NAFLD isn’t caused by drinking too much alcohol.

About non-alcoholic fatty liver disease

If your liver is healthy, there should be little or no fat in it. But sometimes, for a variety of reasons, fat can begin to collect in your liver cells. This can sometimes be due to drinking too much alcohol. But if the build-up of fat isn’t linked to alcohol, it’s called non-alcoholic fatty liver disease (NAFLD). NAFLD is more common if you’re overweight or have diabetes. For more information on this, see our Causes section below.

If you have NAFLD, making changes to your lifestyle, including improving your diet and exercising more, may help to prevent or reverse damage to your liver. See our self-help and diet section below for tips and advice.

NAFLD is emerging as an important cause of liver disease in India. It’s thought that prevalence is as high as 53% in Indian population. Most people who develop NAFLD are between 40 and 60, but it’s becoming increasingly common in children and teenagers. 

Stages of non-alcoholic fatty liver disease

There are different stages or levels of NAFLD.

• Fatty liver (steatosis). This is when fat builds up in the cells of your liver but doesn’t cause any inflammation. Most people with NAFLD will only have this stage.
• Non-alcoholic steatohepatitis (NASH). This is when the build-up of fat causes your liver to become inflamed and damaged.
• Fibrosis. This is when damage to your liver is replaced by fibrous scar tissue. In the early stages, this might be reversible to some extent.
• Cirrhosis. This is when the long-term scarring to your liver becomes severe and irreversible. Your liver becomes harder and its smooth tissue is replaced by hard irregular nodules. Cirrhosis can lead to liver failure.

Symptoms of non-alcoholic fatty liver disease

NAFLD doesn’t usually cause any symptoms in the early stages. You may only find out you have it if it’s found in a test you’re having for something else.

Sometimes, if your liver gets to the stage where it’s damaged, you may get symptoms which can include:

• feeling generally unwell and really tired
• pain or discomfort on the right side of your tummy (abdomen), just under your ribs

Diagnosis of non-alcoholic fatty liver disease

You might only find out that you’ve got a problem with your liver when you have a routine medical test or a test for another health condition. This might include a blood test or an ultrasound scan of your abdomen (tummy).

If one of these test shows there might be a problem with your liver, your Doctor will ask if you have any symptoms and examine you. They’ll also ask you about your medical history and your lifestyle, and may weigh you to check your body mass index (BMI). It’s important to be honest about your lifestyle, and about how much and how often you drink alcohol. This will help your Doctor to make the right diagnosis of the type of fatty liver disease you may have.

If your Doctor suspects you have liver damage, they may refer you to a hepatologist (a doctor who specialises in conditions of the liver).

You’ll be offered a blood test to check how well your liver is working and to check your blood cell count. For more information on this, see our FAQ on liver function tests below. But blood tests alone aren’t always reliable because some people have liver damage despite having normal blood tests. So, your doctor may recommend an ultrasound scan of your abdomen to see if there’s any fat in your liver.

Your Doctor may use the results of blood tests, together with information such as your age and BMI, to assess your risk of liver fibrosis (scarring).

You may also need to have one or more of the following tests.

• Transient elastography (a fibroscan). This is non-invasive test, rather like having an ultrasound scan. A fibroscan measures the stiffness of your liver to see how much fibrosis (scarring) it has. Some fibroscans can also see how much fat there is in your liver.
• A liver biopsy. In this test, your doctor will insert a very fine hollow needle into your liver to collect a small sample of tissue. This is done under local anaesthesia and the sample will be sent to a laboratory to be tested.

If your doctor recommends you have a test, they’ll explain what’s involved and you’ll have the chance to ask any questions.

Treatment of non-alcoholic fatty liver disease

There aren’t any specific treatments yet for NAFLD. Your doctor will encourage you to make changes to your lifestyle to prevent your condition getting worse. For more information about these, see our self-help and diet section below. Your doctor will also recommend treatment for any medical conditions or complications you may have because of your NAFLD.

Medicines

There aren't any medicines to treat NAFLD yet. However, there’s lots of research going on to try to find a treatment, especially for people with the more advanced stages of liver fibrosis and inflammation. There are various medicines that are useful in managing problems associated with NAFLD. For example, your doctor may recommend medicines to treat , , and .

Monitoring

If you have NAFLD, your Doctor will monitor your condition from time to time (probably at least every year). They might refer you to see a specialist for further assessment. This can show if making changes to your lifestyle is working, and help to make sure your liver doesn’t get any worse. Your Doctor will examine you and may do some tests, such as take your blood pressure and measure your body mass index (BMI). You might need to have some blood tests too.

Every three years, your Doctor may re-assess your risk of getting liver fibrosis. They might suggest you have transient elastography (a fibroscan). See our section on diagnosis above for more information on this.

If you stick with the changes you make to your lifestyle, your liver may improve. If you don’t make any changes, your fatty liver may progress into more serious liver disease and damage.

Self-help and diet for non-alcoholic fatty liver disease

If you have NAFLD, you can make lifestyle changes to help stop it getting worse.

• . This can reverse some of the build-up of fat and even some of the fibrosis in your liver. It’s important not to lose weight too quickly though, because this could cause problems with your liver. Aim for 0.5 to 1.0 kg (1 to 2 lbs) per week. For more about what to eat, see our information on diet and fatty liver below.
• . This will help you to lose any excess weight you may have. It may also help to reduce damage to your liver even if you don’t successfully lose any weight.
• If you drink alcohol, it’s important to stay . For more information, see our FAQ: Alcohol and non-alcoholic fatty liver disease below .

Non-alcoholic fatty liver disease diet

If you have NAFLD, you should aim to eat a .

• Choose wholegrain (such as breads, rice and pasta) which are high in .
• Avoid food and drinks that are high in .
• Eat more vegetables and fruit.
• Eat less saturated . Replace saturated fats with monounsaturated fats or polyunsaturated fats, especially omega-3 fatty acids. This may help reduce your risk of which can be linked to NAFLD.
• Monitor your , especially if you’re trying to lose weight.

For more advice on making healthy lifestyle changes, see our ‘Related information’ section below.

Complications of non-alcoholic fatty liver disease

There are several different stages of NAFLD, as described in our section on stages above. Most people just have a fatty liver, and don’t have any long-term effects. But for some people, the build-up of fat causes inflammation and scarring, which can lead to the complication of serious liver disease. This can also increase your risk of getting liver cancer.

If you have NAFLD, especially if you also have type 2 diabetes, you’re more at risk of developing cardiovascular disease, such as a heart attack or stroke. Your doctor will check if anything else is also putting you at risk, and help you take steps to reduce it. For example, they’ll check your blood pressure and cholesterol levels to see if these are within the normal range. You might need to take medicines to control these.

Preventing non-alcoholic fatty liver disease

You can reduce your risk of getting NAFLD by:

• maintaining a healthy weight through eating a healthy, balanced diet
• being active and getting plenty of exercise

For tips and hints on living a healthy lifestyle, see our ‘Self-help and diet’ section above and the related information section below.

Frequently asked questions

Related Information