Non-alcoholic fatty liver disease is now the most common cause of chronic liver disease in the U.S. Some people with excess fat in the liver simply have what’s called a fatty liver. Although this is not normal, it is not serious if it doesn’t lead to inflammation or damage.
Others have what’s called non-alcoholic steatohepatisis (NASH). Although it is similar to alcoholic liver disease, people with this type of fatty liver disease drink little or no alcohol. NASH can lead to permanent liver damage. The liver may enlarge and, over time, liver cells may be replaced by scar tissue. This is called cirrhosis.
The liver cannot function correctly and you may develop liver failure, liver cancer, and liver-related death. NASH is one of the leading causes of cirrhosis.
Both types of NAFLD are becoming more common. Up to 20% of adults may have either fatty liver or NASH.
Recent evidence indicates that NAFLD increases the risk of heart disease in children who are overweight or obese.
Causes of Nonalcoholic Fatty Liver Disease (NAFLD)
The cause of non-alcoholic fatty liver disease is not clear. Certain factors tend to increase the risk, but in some cases, no risk factors show up.
However, NAFLD tends to run in families. It also shows up most often in people who are middle-aged and overweight or obese. These people often have high cholesterol or triglycerides and diabetes or pre-diabetes (insulin resistance), as well.
Other potential causes of fatty liver disease include:
- Viral hepatitis
- Autoimmune or inherited liver disease
- Rapid weight loss
Recent studies show that an overgrowth of bacteria in the small intestine and other changes in the intestine may be associated with nonalcoholic fatty liver disease.
Symptoms of Fatty Liver Disease
Fatty liver disease is often silent, producing no symptoms, especially in the beginning. If the disease advances – which is usually over a period of years, or even decades – it can cause vague problems such as:
- Weight loss or loss of appetite
- Confusion, impaired judgment, or trouble concentrating
These symptoms may also be present:
- Pain in the center or right upper part of the abdomen
- An enlarged liver
- Patchy, dark skin discoloration, usually on the neck or underarm area
With alcoholic liver disease, symptoms may worsen after periods of heavy drinking. With NAFLD, the disease process can stop or reverse, or it may worsen.
If cirrhosis develops, the liver loses its ability to function. This can cause signs and symptoms such as:
- Fluid retention
- Muscle wasting
- Internal bleeding
- Jaundice (yellowing of skin and eyes)
- Liver failure
Diagnosis of Fatty Liver Disease
Often a fatty liver shows up during a routine checkup. Your doctor might notice that your liver is slightly enlarged or see signs of a fatty liver on a blood test. Or, your doctor may suspect a problem after taking a health history or doing a physical exam.
- Blood tests
During routine blood tests, elevations in certain liver enzymes may show up. These might include alanine aminotransferase (ALT) or aspartate aminotransferase (AST).
- Imaging studies
A fatty liver may also show up on imaging tests, such as an abdominal ultrasound.
- Liver biopsy
The only way to confirm a diagnosis of fatty liver disease is with a liver biopsy. This is usually done once other causes have been ruled out. After application of local anesthesia, the doctor inserts a needle through the skin to remove a tiny piece of liver. This is then examined under a microscope for signs of fat, inflammation, and damaged liver cells. If inflammation or damage is not present, the diagnosis is simply a fatty liver.
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