Nonalcoholic Fatty Liver Disease (NFLD)

Overview

Nonalcoholic fatty liver disease (NAFLD) is a prevalent liver condition that primarily affects individuals who consume little to no alcohol. The condition is characterized by an excessive accumulation of fat in the liver and is most commonly observed in individuals who are overweight or obese. The global incidence of NAFLD is on the rise, particularly in Middle Eastern and Western nations, paralleling the increasing prevalence of obesity.

In some cases, NAFLD can progress to a more severe condition known as nonalcoholic steatohepatitis (NASH). NASH represents an advanced stage of fatty liver disease, leading to inflammation and damage to the liver due to the accumulation of fat deposits. This progression may result in worsening conditions, potentially leading to significant liver scarring, known as cirrhosis, and even the development of liver cancer. The damage inflicted by NASH is comparable to the harm caused by prolonged heavy alcohol consumption.

Currently, there is a movement to rename nonalcoholic fatty liver disease to metabolic dysfunction-associated steatotic liver disease (MASLD). Additionally, experts are recommending a similar name change for nonalcoholic steatohepatitis to metabolic dysfunction-associated steatohepatitis (MASH). This shift in nomenclature reflects a broader recognition of the underlying metabolic factors contributing to these liver conditions, aiming to enhance understanding and treatment approaches for these increasingly prevalent health issues.

Symptoms

NAFLD often presents without noticeable symptoms. When symptoms do manifest, they might include:

• Fatigue.
• Malaise
• Pain or discomfort in the upper right abdomen.

Potential symptoms associated with NASH (nonalcoholic steatohepatitis) and cirrhosis (advanced liver scarring) include:

• Itchy skin.
• Abdominal swelling, referred to as ascites.
• Shortness of breath.
• Leg swelling.
• Spider-like blood vessels just beneath the skin’s surface.
• Enlarged spleen.
• Red palms.
• Jaundice – yellowing of the skin and eyes.

Causes

The factors leading to the accumulation of fat in specific livers and the progression from non-alcoholic fatty liver disease (NAFLD) to non-alcoholic steatohepatitis (NASH) remain unclear to experts. Both NAFLD and NASH are linked to:

• Genetic factors.
• Excess weight or obesity.
• Elevated levels of fats, especially triglycerides, in the blood.
• Type 2 diabetes, characterized by high blood sugar or hyperglycemia.
• Insulin resistance, where cells do not efficiently respond to insulin, affecting sugar uptake.

While these health issues together may play a role in the development of a fatty liver, it’s important to note that some individuals can still develop non-alcoholic fatty liver disease (NAFLD) even without these specific risk factors.

Risk factors

Various diseases and health conditions can elevate the risk of non-alcoholic fatty liver disease (NAFLD). These include:

• Family history: A familial predisposition to fatty liver disease or obesity.
• Growth hormone deficiency: Insufficient production of growth hormones in the body.
• High cholesterol: elevated levels of cholesterol in the blood.
• Insulin resistance: The body’s reduced responsiveness to insulin.
• Type 2 diabetes: A condition marked by elevated blood sugar levels.
• High triglycerides: Increased levels of triglycerides in the bloodstream.
• Obesity: Particularly when excess fat accumulates around the waist.
• Metabolic syndrome: A cluster of conditions like high blood pressure, elevated triglycerides, and central obesity.
• Polycystic ovary syndrome (PCOS): A hormonal disorder affecting individuals with ovaries.
• Obstructive sleep apnea: A sleep disorder characterized by interrupted breathing during sleep.
• Underactive thyroid (hypothyroidism): Insufficient production of thyroid hormones.
• Underactive pituitary gland (hypopituitarism): Reduced function of the pituitary gland.

Additionally, non-alcoholic steatohepatitis (NASH) is more likely in certain groups:

• Individuals above the age of 50.
• People grappling with obesity.
• Those with specific genetic risk factors.
• Individuals dealing with diabetes or high blood sugar.
• Those exhibiting symptoms of metabolic syndrome, such as high blood pressure, elevated triglycerides, and an enlarged waist size.

Distinguishing between NAFLD and NASH necessitates a clinical evaluation and appropriate testing.