The term NAFLD refers to several conditions brought on by an accumulation of fat in the liver. Obese or overweight people frequently exhibit it.
The majority of the time, early-stage NAFLD is harmless, but if it worsens, it can result in severe liver damage, including cirrhosis.
An increased risk of significant health issues, including diabetes, high blood pressure, and renal disease, is also linked to having high levels of fat in your liver.
NAFLD raises your risk of getting cardiac problems if you already have diabetes.
It is possible to prevent NAFLD from getting worse and lower the amount of fat in your liver if it is identified and treated at an early stage.
Stages of NAFLD
NAFLD progresses via 4 key phases.
Typically without being aware of it, the majority of people will only ever reach the first stage. If it is not identified and treated, it can occasionally worsen and finally result in liver damage.
The primary NAFLD phases are:
Simple fatty liver (steatosis), a mostly benign accumulation of fat in the liver cells, is only occasionally identified after tests performed for other reasons.
Non-alcoholic steatohepatitis (NASH) is a more severe variation of NAFLD in which the liver has inflammatory changes.
Fibrosis: a condition in which the liver and adjacent blood arteries develop scar tissue as a result of ongoing inflammation, yet the liver continues to function normally.
Cirrhosis – the most severe stage, occurring after years of inflammation, in which the liver shrinks and becomes scarred and lumpy. This damage is permanent and can lead to liver failure and liver cancer.
Fibrosis or cirrhosis may take years to manifest. Lifestyle changes are necessary to stop the problem from getting worse.
Am I at risk of NAFLD?
You have a higher chance of developing NAFLD if you:
are overweight or obese, especially if you have a lot of belly fat (an “apple-like” body shape)
suffer with type 2 diabetes
possess a disease that impairs how well your body uses insulin
are insulin resistant, such as with polycystic ovary syndrome
have a thyroid that is not functioning properly
have high blood pressure
have elevated cholesterol
possess the metabolic syndrome (a combination of diabetes, high blood pressure and obesity)
are over 50 years old
smoke
However, NAFLD has been identified in patients, including young children, who do not have any of these risk factors. NAFLD is not brought on by excessive alcohol consumption, despite closely resembling alcohol-related liver disease (ARLD).
Symptoms of NAFLD
Early on in NAFLD’s development, symptoms are typically non-existent. The likelihood is that you won’t be aware that you have it unless it is discovered via testing done for another reason.
People with NASH or fibrosis may occasionally experience:
a dull or sharp stomach ache in the top right corner (over the lower right side of the ribs)
If cirrhosis (the most advanced stage) develops, you may experience more severe symptoms such as swelling in the legs, ankles, feet or abdomen (oedema), itchy skin, and yellowing of the skin and the whites of the eyes (jaundice).
How is NAFLD diagnosed?
NAFLD is frequently identified after a blood test known as a liver function test yields an abnormal result and other liver disorders, such as hepatitis, are ruled out.
However, NAFLD is not always detected by blood tests.
An ultrasound machine scan of your abdomen may also reveal the issue. In this kind of scan, sound waves provide an image of your body’s interior.
Additional testing may be required to identify your stage of NAFLD if you are diagnosed. This can entail undergoing a specific blood test or a different kind of ultrasound exam (Fibroscan).
Some people might also require a biopsy, which entails taking a tiny sample of liver tissue with a needle so that it can be examined in a lab.
Every three years, children and adolescents at risk for NAFLD (those with type 2 diabetes or metabolic syndrome) should have a liver ultrasound. A CT scan or MRI scan are two other examinations you might undergo.
Treatment for NAFLD
Most people with NAFLD won’t have any significant issues, but if you are diagnosed, it’s a good idea to take action to prevent the illness from worsening.
Although there isn’t a specific treatment for NAFLD yet, adopting a healthy lifestyle can help. You could visit your doctor regularly to have your liver function evaluated and to search for any indicators of emerging issues. Treatment may also be advised for accompanying diseases or consequences, such as high blood pressure, diabetes, or cholesterol.
Medicines
The symptoms of NAFLD can be managed with various medications, but there is presently no medication that can treat the disease. For instance, your doctor might suggest medication to address obesity, type 2 diabetes, high blood pressure, or high cholesterol.
Liver transplant
You might need to be added to the liver transplant waiting list if you develop severe cirrhosis and your liver begins to malfunction. Or a transplant utilising a piece of liver taken from a living donor would also be possible.
The transplanted portion of the liver and the remaining portion of the donor’s liver can both regenerate and enlarge to their normal sizes once the liver has the ability to do so.
Things you can do if you have NAFLD
The primary method of managing NAFLD is to adopt a healthy lifestyle.
For instance, you could:
Decrease weight—you should aim for a BMI of 18.5 to 24.9. If you lose more than 10% of your body weight, some of the fat in your liver will be removed, which will help if you already have NASH.
Eat a healthy diet – try to eat a balanced diet that is high in fruits, vegetables, protein, and carbohydrates while being low in fat, sugar, and salt. Eating smaller quantities of food can help, as can drinking water instead of sweet drinks.
Exercise on a regular basis – aim for at least 150 minutes of moderate-intensity movement per week, such as walking or cycling. All sorts of exercise can help improve NAFLD even if you do not lose weight.
Stop smoking – If you smoke, quitting can help lower your risk of heart attacks and strokes.
Alcohol does not cause NAFLD, but it may make it worse. Therefore, it is advised to reduce or stop drinking alcohol.
Alcohol-related liver disease
Drinking too much alcohol damages the liver. Over time, this may potentially lead to liver disease brought on by alcohol. Cirrhosis is the last manifestation of alcohol-induced liver damage. It usually happens after several years of heavy drinking.
What exactly is cirrhosis of the liver?
The development of fibrotic scarring over healthy liver tissue, which is also destroyed in the process, is a hallmark of liver cirrhosis. Cirrhosis is typically the result of years of liver damage, whether from years of heavy alcohol use or from another health issue that goes untreated for a long time. It is not a disease that manifests itself suddenly. Similar to fatty liver disease, the early stages of liver cirrhosis typically do not result in symptoms. Nevertheless, you can have some of the following cirrhosis symptoms:
These are a few consequences that might materialise as the illness worsens over time.
How long does it take for fatty liver to turn into cirrhosis?
It was once believed that it took decades to move from early-stage NAFLD to cirrhosis, but new studies have shown that it can only take two years for some people.
What percentage of fatty liver turns to cirrhosis?
NASH patients are between 5 and 12% more likely to develop cirrhosis.
Symptoms of Cirrhosis
Cirrhosis frequently goes undetected until there is severe liver damage. When symptoms do materialise, they may include:
Fatigue
Easy bleeding or bruising
Lower appetite
Nausea
Legs, feet or ankles swell (edema)
Weight loss
Itchy skin
Yellow skin and eyes (jaundice)
Fluid retention in the abdomen (ascites)
Spiderlike blood vessels on the skin
Redness in hands` palms
Absence or loss of menstruation in women (out of menopause)
Loss of sex drive, breast enlargement (gynecomastia) or testicular atrophy for men
Confusion, drowsiness and slurred speech (hepatic encephalopathy)
Causes of Cirrhosis
Cirrhosis can result from liver damage brought on by a variety of illnesses and situations.
Among the causes are:
Chronic alcohol abuse
Chronic viral hepatitis (B, C and D)
Fat accumulating in the liver (non-alcoholic fatty liver disease)
Iron build up in the body (hemochromatosis)
Cystic fibrosis
Copper accumulating in the liver (Wilson’s disease)
Poorly formed bile ducts (biliary atresia)
Alpha-1 antitrypsin deficiency
Inherited disorders of sugar metabolism (galactosemia or glycogen storage disease)
Genetic digestive disorder (Alagille syndrome)
Liver disease related to the body’s immune system (autoimmune hepatitis)
Destruction of the bile ducts (primary biliary cirrhosis)
Hardening and scarring of the bile ducts (primary sclerosing cholangitis)
Infection, such as syphilis or brucellosis
Medications, including methotrexate or isoniazid
Risk factors for Cirrhosis
Excessive alcohol consumption – a risk factor for cirrhosis is excessive alcohol use.
Heavyweight – obesity increases the likelihood of ailments including non-alcoholic steatohepatitis and non-alcoholic fatty liver disease, which can both result in cirrhosis.
Having viral hepatitis – even though cirrhosis does not always result from chronic hepatitis, it is one of the main causes of liver disease worldwide.
How to prevent cirrhosis
Drinking within the suggested guidelines is the greatest method to avoid developing alcohol-related cirrhosis.
The recommended action is:
Regular alcohol consumption for both men and women shouldn’t exceed 14 units per week.
If you use up to 14 units per week, you should spread your drinking out over 3 days or more.
If you have alcohol-related cirrhosis, stop drinking right away. Regardless of the reason, drinking alcohol hastens the progression of cirrhosis.
A doctor can offer support and guidance if you’re having trouble reducing your drinking.
Aim for a healthy weight
Make sure you’re at a healthy weight by following a healthy, balanced diet and engaging in regular exercise to lower your risk of developing the non-alcoholic fatty liver disease (NAFLD), which can result in cirrhosis.
Dangers of Cirrhosis
Complications of cirrhosis can include:
High blood pressure in the veins that supply the liver (portal hypertension)
Swelling in the legs and abdomen
Enlargement of the spleen (splenomegaly)
Bleeding
Infections
Malnutrition
A buildup of toxins in the brain (hepatic encephalopathy)
Jaundice
Bone disease
Increased risk of liver cancer
Acute-on-chronic cirrhosis
Treating cirrhosis
Cirrhosis currently has no known cure. There are, however, techniques to control the signs and associated side effects as well as stop the disease’s growth.
Cirrhosis can be prevented from worsening by addressing the issue that caused it, such as treating hepatitis C with antiviral medications, for example. It can be suggested to you to cut back or quit drinking alcohol, or, if you’re overweight, to lose weight.
A doctor can assist you in finding support if you need assistance quitting drinking or losing weight; however, a liver transplant may be the sole choice for treatment if the condition seriously damages your liver.
Cirrhosis Prevention
By taking the following care of your liver, you can lessen your risk of developing cirrhosis:
Avoid drinking – alcohol use is not advised if you have liver illness.
Adopt a balanced diet – decide to eat a plant-based, fruit and vegetable-rich diet. Choose lean protein sources and healthy carbohydrates. Limit your intake of fried and fatty foods.
Keep a healthy weight – having too much body fat can harm your liver. If you are obese or overweight, discuss a weight-loss strategy with your doctor.
Lessen your hepatitis risk – your risk of contracting hepatitis B and C can increase if you share needles and engage in unprotected sex. Consult your physician for hepatitis vaccines.
Fatty Liver Disease vs Cirrhosis: Know the Difference
To maintain excellent general health, one must maintain a healthy digestive system, and the liver is one of the digestive system’s most vital organs. The liver is in charge of a number of vital functions, including the metabolism of lipids, carbohydrates, and proteins, the production of bile, the preservation of glycogen and minerals, and the elimination of medications and hormones, among many other things. However, the condition might have a detrimental effect on your health if the liver is afflicted. Cirrhosis and fatty liver disease are two of these conditions.
Hepatic steatosis is a problem marked by the existence of fat cells within the liver. This condition has a couple of principal classifications: non-alcoholic fatty liver disease (NAFLD) and alcoholic fatty liver disease (AFLD). While an excess of drinking causes AFLD, NAFLD could be induced by obesity, type 2 diabetes, or high cholesterol. Recognising whether you have hepatic steatosis can be tough because the problem usually does not lead to any notable symptoms. Still, specialists can identify it with blood work, imaging tests, or sometimes a biopsy of the liver.
Key differences between fatty liver disease and cirrhosis
Although both cirrhosis and fatty liver disease affect the liver, there are a few significant differences to be aware of.
The accumulation of fat cells in the liver is the hallmark of fatty liver disease, whereas the development of scar tissue over healthy tissue is the hallmark of cirrhosis.
The prevalence of fatty liver disease is considerably higher than cirrhosis. If not treated promptly, both types of fatty liver disease (AFLD and NAFLD) can result in cirrhosis. Both conditions require time to develop, but cirrhosis develops a far more severe problem.
It’s critical to get treatment as soon as you can if you suspect you have one of these conditions. Despite the possibility of chronicity in both situations, maintaining your health is essential for your welfare.
Last Edited: September 19th, 2022
Clinically Reviewed: July 12, 2022
Clinical Reviewer
Michael
BACP accredited psychotherapist with 16 years experience working in mental health specialising in psychodynamic person-centred therapies treating those with a range of mental health disorders including anxiety, depression, OCD and Addiction.
