Fatty Liver Disease

Non-Alcohol related Fatty Liver Disease (NAFLD) is a condition whereby excess fat is deposited in the liver. This type of liver disease is becoming more prevalent and is now one of the most common liver disorders that a GP or liver specialist will see. The British Liver Trust estimate that up to 20% of the UK population have early signs of the disease. Only a small proportion of patients with NAFLD, however, will progress to the advanced stages of liver disease such as cirrhosis. Simple tests are available to determine which patients may be at risk of progression, and interventions are available to modify the disease and prevent it from worsening.

Who is affected by Non-Alcohol related Fatty Liver Disease?

The condition was first called non-alcohol related fatty liver disease as the changes seen within the liver can also occur with excess alcohol consumption. It is strongly associated with health disorders that are very common in the population, such as late onset (type 2) diabetes, obesity, high cholesterol and high blood pressure. It is important to highlight that not all patients with diabetes or obesity will progress to advanced liver disease and that often the amount of fat in the liver can be reduced or even eliminated with targeted lifestyle changes.

What causes NAFLD?

The exact reasons why fat builds up in the liver and how this causes liver damage are still an area of active research. A high-calorie diet and a lack of exercise are certainly contributing factors. It also seems that there are some people with an inherited tendency to this condition, particularly those with a personal or family history of late-onset (type 2) diabetes. Over time, the accumulation of fat can lead to inflammation of the liver cells which can then cause a build-up of scar tissue (fibrosis). The accumulation of large amounts of fibrosis can result in cirrhosis and thereafter abnormalities of liver function.

How is NAFLD diagnosed?

The first indication that someone may have fatty liver disease (NAFLD) is detected on routine liver function tests (LFTs). The abnormality if often only mild and is frequently found by chance. NAFLD does not cause symptoms in a majority of patients. A fatty appearing liver can also be found an incidental finding of a routine abdominal scanning, such as an ultrasound scan.

NAFLD is usually suspected in a patient who has risk factors for the condition and when other liver conditions such as viral hepatitis and alcohol-related liver disease are excluded. In the past, the diagnosis was often confirmed by a liver biopsy, which involved taking a small sample of liver tissue to examine under the microscope. This is sometimes required, but in the vast majority of cases, clinicians are able to perform a simple scan instead, called a Fibroscan. This is a non-invasive procedure with no risk to the patient. It allows us to both measure the amount of fat (steatosis) within the liver and also to assess for any liver scarring (fibrosis).

What is the treatment of NAFLD?

The main form of treatment is to control or modify factors that contribute to NALFD. These usually involve Lifestyle measures such as losing weight and taking regular exercise. Good control of diabetes or cholesterol is also important, we can advise and support our patients in order to have a positive impact on disease progression. As yet there are no direct interventions or medications for fatty liver disease itself, but this is an area of active research and novel treatments are expected to be available for clinical use in the near future.