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Nonalcoholic fatty liver disease

Nonalcoholic fatty liver disease is a term used to describe the accumulation of fat in the liver of people who drink little or no alcohol.

Nonalcoholic fatty liver disease is common and, for most people, causes no signs and symptoms and no complications.

But in some people with nonalcoholic fatty liver disease, the fat that accumulates can cause inflammation and scarring in the liver. This more serious form of nonalcoholic fatty liver disease is sometimes called nonalcoholic steatohepatitis.

At its most severe, nonalcoholic fatty liver disease can progress to liver failure.

Nonalcoholic fatty liver disease usually causes no signs and symptoms. When it does, they may include:

  • Fatigue
  • Pain in the upper right abdomen
  • Weight loss

When to see a doctor

Make an appointment with your doctor if you have persistent signs and symptoms that cause you concern.

Nonalcoholic fatty liver disease occurs when your liver has trouble breaking down fats, causing fat to build up in your liver tissue.

Doctors aren’t sure what causes nonalcoholic fatty liver disease. The wide range of diseases and conditions linked to nonalcoholic fatty liver disease is so diverse that it’s difficult to pinpoint any one cause.

Types of nonalcoholic fatty liver disease

Nonalcoholic fatty liver disease can take several forms — from harmless to life-threatening. Forms include:

  • Nonalcoholic fatty liver. It’s not normal for fat to build up in your liver, but it won’t necessarily hurt you. In its simplest form, nonalcoholic fatty liver disease can cause excess liver fat, but no complications. This condition is thought to be very common.
  • Nonalcoholic steatohepatitis. In a small number of people with fatty liver, the fat causes inflammation in the liver. This can impair the liver’s ability to function and lead to scarring of the liver (cirrhosis).
  • Nonalcoholic fatty liver disease-associated cirrhosis. Liver inflammation leads to scarring of the liver tissue. With time, scarring can become so severe that the liver no longer functions adequately (liver failure).
A wide range of diseases and conditions can increase your risk of nonalcoholic fatty liver disease, including:

  • Gastric bypass surgery
  • High cholesterol
  • High levels of triglycerides in the blood
  • Metabolic syndrome
  • Obesity
  • Polycystic ovary syndrome
  • Sleep apnea
  • Type 2 diabetes
  • Underactive thyroid (hypothyroidism)
  • Underactive pituitary gland (hypopituitarism)
Tests and procedures used to diagnose nonalcoholic fatty liver disease include:

  • Blood tests. Liver function tests, including tests of liver enzymes, may help your doctor make a diagnosis.
  • Imaging procedures.Imaging procedures used to diagnose fatty liver disease include ultrasound, computerized tomography (CT) scan and magnetic resonance imaging (MRI).
  • Liver tissue testing. If it’s suspected that you have a more serious form of nonalcoholic fatty liver disease, your doctor may recommend a procedure to remove a sample of tissue from your liver (liver biopsy). The tissue sample is examined in a laboratory to look for signs of inflammation and scarring.Liver biopsy is typically done using a long needle inserted through your skin and into your liver to remove liver cells (needle biopsy).
No standard treatment for nonalcoholic fatty liver disease exists.

Instead, doctors typically work to treat the risk factors that contribute to your liver disease. For instance, if you’re obese, your doctor can help you to lose weight through diet, exercise and, in some cases, medications and surgery.

Your doctor may recommend that you receive vaccinations against hepatitis A and hepatitis B to help protect you from viruses that may cause further liver damage.

Along with your doctor’s help, you can take steps to control your nonalcoholic fatty liver disease. You can:

  • Lose weight. If you’re overweight or obese, reduce the number of calories you eat each day and increase your physical activity in order to lose weight. If you’ve tried to lose weight in the past and have been unsuccessful, ask your doctor for help.
  • Choose a healthy diet. Eat a healthy diet that’s rich in fruits, vegetables and whole grains.
  • Exercise and be more active. Aim for at least 30 minutes of exercise most days of the week. If you’re trying to lose weight, you might find that more exercise is helpful. But if you don’t already exercise regularly, get your doctor’s OK first and start slowly.
  • Control your diabetes. Follow your doctor’s instructions to stay in control of your diabetes. Take your medications as directed and closely monitor your blood sugar.
  • Lower your cholesterol. A healthy plant-based diet, exercise and medications can help keep your cholesterol and your triglycerides at healthy levels.
  • Protect your liver. Avoid things that will put extra stress on your liver. For instance, don’t drink alcohol. Follow the instructions on all medications and over-the-counter drugs.
No alternative medicine treatments are proven to cure nonalcoholic fatty liver disease. But researchers are studying whether some natural compounds could be helpful, such as:

  • Vitamin E. In theory, vitamin E and other vitamins called antioxidants could help protect the liver by reducing or neutralizing the damage caused by inflammation. But more research is needed.Some evidence suggests vitamin E supplements may be helpful for people with liver damage caused by nonalcoholic fatty liver disease. But vitamin E has side effects, such as an increased risk of death and, in men, an increased risk of prostate cancer.Discuss the benefits and risks of vitamin E with your doctor.
  • Coffee. In one study, people with nonalcoholic fatty liver disease who reported drinking coffee had less liver damage than those who drank little or no coffee. It’s not clear how coffee may influence liver damage or how much coffee you’d need to drink in order to benefit.If you already drink coffee, these results may make you feel better about your morning cup of coffee. But if you don’t already drink coffee, this probably isn’t a good reason to start. Discuss the potential benefits of coffee with your doctor.