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What is Non Alcoholic Fatty Liver Disease (NAFLD)

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What is Non Alcoholic Fatty Liver Disease (NAFLD)

Dr. Ankur Gupta- Gastroenterology
Consultant - Gastroenterology

Liver disease is very common in India. Research data shows in India shows that up to 30% of population may have liver related problems. Continuing liver problems leads to liver fibrosis and cirrhosis (liver does not work properly due to long term damage), which accounts for more than 200,000 deaths in India every year. Liver cirrhosis is one of the top 10 causes of death worldwide and 1/5th of the global deaths occur due to cirrhosis occur in India. NAFLD (Non Alcoholic Fatty Liver Disease)  is a lifestyle disease that occurs in individuals with improper diet, lacking in exercise, tendency to accumulate fat around stomach, and with lipid and sugar related problems in blood that occurs in about 1/3rd of population in India.

NAFLD is the commonest cause of chronic liver disease in the west and is increasingly common problem in India. The other causes are alcohol and hepatitis B & C infections. Such patients can progress to chronic liver disease with fibrosis and cirrhosis without having any symptoms and with essentially normal liver function test. Hence an early diagnosis is difficult and often missed. By the time patients develop jaundice, ascites, encephalopathy, and gastrointestinal bleeding, the liver disease is advanced and the lifespan of the patient is significantly reduced. About 50% of patients witnessing above symptoms die within 1 - 1 1/2 years of diagnosis. It is therefore of utmost importance that an early diagnosis is made so that early treatment may prevent disease progression.

NAFLD is a very common disorder and refers to a group of conditions where there is accumulation of excess fat in the liver of people who drink little or no alcohol. The most common form of NAFLD is a non serious condition called fatty liver. In fatty liver, fat accumulates in the liver cells. Although having fat in the liver is not normal, by itself it probably does not damage the liver.

Signs and Symptoms of Fatty Liver Disease

The majority of individuals with NAFLD have no symptoms and a normal examination. Some patients may exhibit symptoms such as abdominal pain, which may be in the center or the right upper part of the abdomen, and sometimes fatigue. However, other causes of abdominal pain and fatigue should be considered. On physical examination the liver might be slightly enlarged.

  • Loss of appetite
  • Abdominal pain
  • Jaundice
  • Fatigue
  • Swollen abdomen
  • Patchy, dark discoloration of skin that is present most commonly over the neck and under arm area.
  • Bloating of stomach
  • Vomiting
  • Constipation
  • Rectal pain or bleeding

Causes of NAFLD

NAFLD is part of the metabolic syndrome characterized by diabetes, or pre-diabetes (insulin resistance), being overweight or obese, elevated blood lipids such as cholesterol and triglycerides, as well as high blood pressure. Not all patients have all the manifestations of the metabolic syndrome.


The diagnosis of NAFLD is usually first suspected in an overweight or obese person who is found to have mild elevations in their liver tests during a routine blood testing or incidentally detected on radiologic investigations such as abdominal ultrasound or CT scan. Some experts are now recommending that every obese child or adolescent should have these liver enzymes checked. However NAFLD can be present with normal liver blood tests. The diagnosis of NAFLD is confirmed by imaging studies, most commonly a liver ultrasound, showing accumulation of fat in the liver. Fat accumulation in the liver can also be caused by excess alcohol intake, certain medications, viral hepatitis, autoimmune liver disease, and metabolic or inherited liver disease. . The liver biopsy provides essential information regarding the degree of scarring within the liver, which would not be apparent on a blood test, ultrasound, or an x-ray alone. Liver biopsy rarely can be associated with serious risks including bleeding and patients should discuss the risks and benefits of the procedure with their physician.

Treatment of NAFLD

A few studies have suggested that weight loss may be associated with regression of fat within the liver. Therefore, the most important recommendations for people with fatty liver are:

  1. To lose weight if they are overweight or obese 
  2. Increase their physical activity
  3. Follow a balanced diet  
  4. Avoid alcohol and unnecessary medications.
  5. Increase intake of Mediterranean diet (rich in monounsaturated fatty acids) which is more beneficial than low fat diet.
  6. Drink more coffee as it will reduce the risk of having a fatty liver.