• Nonalcoholic Fatty Liver Disease

    (NAFLD, Nonalcoholic Steatohepatitis [NASH])

    Definition

    Nonalcoholic fatty liver disease involves the build-up of fat in the liver of people who drink little or no alcohol. It is a common condition. Fatty liver disease may not cause any problems if it is mild. In some cases, it can cause inflammation and scarring in the liver. If this is severe, it can cause liver failure.
    The Liver
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    Causes

    When the liver is unable to break down fats, they build up in liver tissue. Many conditions and diseases make it difficult for the liver to break down fats.

    Risk Factors

    These factors increase your chance of developing fatty liver disease:
    • Being overweight or obese
    • Age (risk increases with age)
    • Gender (affects males more than females)
    • Type 2 diabetes
    • High cholesterol
    • Severe weight loss
    • Medicines (eg, steroids)
    • Exposure to certain chemicals (eg, pesticides)
    Tell your doctor if you have any of these.

    Symptoms

    This disease often causes no symptoms. If fatty build-up is causing the liver not to function well, you may have symptoms. If you have any of these symptoms, do not assume it is due to fatty liver disease. These may be caused by other conditions. Tell your doctor if you have any of these:
    • Fatigue
    • Pain in the upper right side of the abdomen
    • Muscle weakness
    • Jaundice
    • Skin itching (pruritus)
    • Lack of appetite
    • Weight loss
    • Nausea

    Diagnosis

    Your doctor will ask about your symptoms and medical history. A physical exam will also be done.
    Tests may include the following:
    • Blood tests—to look for raised liver enzymes
    • Ultrasound—a test that uses sound waves to examine the liver
    • CT scan —a type of x-ray that uses a computer to make pictures of structures inside the abdomen
    • Liver biopsy —a small piece of your liver is removed and examined

    Treatment

    Treatment focuses on the factors that are causing fatty liver disease. Talk with your doctor about the best treatment plan for you. Treatment may focus on avoiding certain medicines, chemicals, or lifestyle factors that can damage your liver.

    Weight Loss

    If you are overweight, your doctor may recommend weight loss through:
    • Diet
    • Exercise
    • Behavioral therapy
    • Medicines
    • Bariatric surgery (in serious cases)

    Medications

    Your doctor may prescribe medicines to lower your cholesterol or improve your blood sugar control. If you have diabetes, your doctor will help you keep your blood sugar levels in a healthy range.

    Prevention

    To help reduce your chance of getting fatty liver disease, take the following steps:
      Maintain a healthy weight.
      • Follow a low-fat, low-calorie diet to promote weight loss.
      • Eat a diet that is rich in fruits and vegetables and unsaturated fats.
      Increase your daily activity levels. For instance:
      • Get 30 minutes of daily exercise.
      • Walk up the stairs instead of riding the elevator.
      • Walk rather than drive for short trips.
    • If you have diabetes or high cholesterol, follow your doctor’s guidelines.

    RESOURCES

    American Gastroenterological Association http://www.gastro.org/

    American Liver Foundation http://www.liverfoundation.org/

    CANADIAN RESOURCES

    The Canadian Association of Gastroenterology http://www.cag-acg.org/

    Canadian Liver Foundation http://www.liver.ca/

    References

    Bayard M, Holt J, Boroughs E. Nonalcoholic fatty liver disease. Am Fam Physician . 2006;73(11):1961-1968.

    DynaMed Editors. Nonalcoholic fatty liver disease. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated May 14, 2010. Accessed June 9, 2010.

    Mayo Clinic. Nonalcoholic fatty liver disease. Mayo Clinic website. Available at: http://www.mayoclinic.com/print/nonalcoholic-fatty-liver-disease/DS00577/DSECTION=all&METHOD=print . Updated February 19, 2009. Accessed 7 June, 2010.

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