Most people live a long life with nonalcoholic fatty liver disease (NAFLD). However:
- 30% of people develop an inflamed liver or nonalcoholic steatohepatitis (NASH) and scarring
- 20% of people with scarring and NASH can develop end-stage cirrhosis, leading to liver failure and cancer.
According to statistics, NAFLD may reduce life expectancy by about 4.2 years for women (95% confidence interval 1.1-7.5) and about 4.4 years for men.
For some people, the fatty liver may reverse, whereas for others, the fatty liver may progress to inflammation and ultimately liver cell damage.
What is NAFLD?
While it’s normal for a healthy liver to contain a small amount of fat, problems occur when fat reaches 5%-10% of the weight of the liver.
Nonalcoholic fatty liver disease is fat buildup in the liver caused by factors other than alcohol. It is often a silent disease because most people don’t experience any symptoms.
Most people with NAFLD have fat in their liver without developing liver damage. However, a few people may progress to NASH.
What are the symptoms of NAFLD?
Most people with NAFLD do not experience symptoms. Some experience fatigue and pain or discomfort in the upper right abdomen.
Symptoms are visible when NAFLD progresses and develops inflammation and scarring. Possible signs and symptoms of NASH and advanced scarring include:
- Ascites (abdominal swelling)
- Jaundice (yellowing of the skin)
- Enlarged spleen
- Red palms
- Spider-like blood vessels just beneath the skin’s surface
- Severe tiredness
- Weight loss
- Long-lasting itching
- Fluid retention
- Internal bleeding
- Muscle wasting
People with cirrhosis can develop liver failure and may need a liver transplant.
What causes NAFLD?
There is no specific reason why some people accumulate fat in the liver. It is likewise unclear what causes NAFLD to progress to NASH.
Common causes of NAFLD and NASH include:
- Overweight or obesity
- Insulin resistance
- Hyperglycemia (high blood sugar level), indicating prediabetes or type II diabetes
- High triglyceride level in the blood
Risk factors for NAFLD or NASH include:
- High cholesterol
- High levels of triglycerides in the blood
- Type II diabetes
- Hypothyroidism (underactive thyroid gland)
- Hypopituitarism (underactive pituitary gland)
- Metabolic syndrome
- Obesity, particularly abdominal fat
- Polycystic ovary syndrome (PCOS)
- Sleep apnea
- Older age
What are the complications of NAFLD?
As nonalcoholic fatty liver disease progresses, it can cause inflammation in the liver. As the liver tries to stop the inflammation, areas of scarring or cirrhosis develop. With growing inflammation, cirrhosis covers the entire liver tissue and can trigger liver failure. If cirrhosis isn’t reversed, it can lead to:
- Ascites (accumulation of fluid in the abdomen)
- Esophageal varices (swelling of veins in the esophagus, leading to rupture and bleeding)
- Hepatic encephalopathy (a nervous system disorder caused by severe liver disease leading to confusion, drowsiness, and slurred speech)
- Liver cancer
- End-stage liver failure (liver has stopped functioning)
Can NAFLD be treated?
Early nonalcoholic fatty liver disease can be reversed with simple lifestyle changes such as:
- Losing weight
- Controlling diabetes
- Avoiding alcohol
- Lowering your cholesterol or triglycerides
There is no medication available to reverse fat buildup in the liver. If you have NASH, you should avoid things that would contribute to fat buildup, which include:
- Excessive use of over-the-counter drugs, especially nonsteroidal anti-inflammatory drugs
- Alcohol consumption
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