Patients & the Public

What Exactly is NAFLD?

NAFLD is characterised by the build-up of excess fat in the liver of people who do not drink more than recommended guideline amounts of alcohol. The first stage is fatty liver, or steatosis. This is where fat accumulates in the liver cells without any inflammation or scarring. For many people, the condition will not advance and a serious liver condition will not develop, but for some, NAFLD can progress on to NASH. NASH is a more significant condition, as it may cause scarring to the liver, and can progress to cirrhosis. Cirrhosis causes irreversible damage to the liver and is the most severe stage of NAFLD. It may be easiest to think of NAFLD as having the following stages:

  1. Non-alcohol related fatty liver or steatosis
  2. Non-alcohol related steatohepatitis (NASH)
  3. NASH with fibrosis
  4. Cirrhosis.

What are The Symptoms?

Most people with mild NAFLD are unlikely to notice any symptoms. Some may experience discomfort in the liver area and tiredness.

For those who go on to develop NASH, Fibrosis and Cirrhosis it may be many years before symptoms develop. The following symptoms may indicate a serious development in your liver condition. Patients with a liver condition who develop any of the following symptoms should see urgent medical attention:

  • yellowness of the eyes and skin (jaundice)
  • bruising easily
  • dark urine
  • swelling of the lower tummy area (ascites)
  • vomiting blood (haematemesis)
  • dark black tarry faeces (melena)
  • periods of confusion or poor memory (encephalopathy)
  • itching skin (pruritus)

How is NAFLD Diagnosed?

In most cases people only find out they have a fatty liver when a routine blood sample (usually liver function tests) shows there may be a problem. If this happens you may be asked a lot of questions about your lifestyle, such as, any drugs you are taking (including over-the-counter medication and nutritional supplements), your diet, the amount of exercise you do and the amount of alcohol you drink.

Further tests may be needed to confirm the diagnosis such as an Ultrasound, FibroScan, CT or CAT Scan or MRI scan. In some cases a liver biopsy may be needed.

What Treatments are Available?

There are no approved medicines for the treatment of NAFLD or NASH.  However, many drug therapies are being examined in in clinical trials.  A better understanding of NAFLD may allow a Precision Medicine approach in the future (delivering the right treatment, to the right patient, at the right time.)

However, if your NAFLD is linked to being overweight then you will be advised to make various lifestyle changes including losing weight gradually and taking sensible exercise. There is good evidence that gradual weight loss coupled with increased exercise can reduce the amount of fat in your liver.

In mild cases of NAFLD doctors may concentrate on treating associated conditions, such as obesity and diabetes, which can cause fat to build up. They will also treat disorders such as high blood pressure and high cholesterol as these are often associated with NAFLD.