Your guide to non-alcoholic fatty liver disease, diagnoses and treatment.

Non-alcoholic fatty liver disease (NAFLD), as its name implies, is the buildup of fat in the liver not caused by heavy alcohol use. In the United States, NAFLD is one of the most common causes of liver disease. It is estimated that about 24% of U.S. adults have NAFLD.

People with NAFLD may not have any symptoms, although some people have reported feeling tired or having upper right side abdominal pain.

It is unclear as to what causes NAFLD. However, there are certain risk factors which make individuals more likely to develop this disease. These risk factors include:

• Overweight or obesity
• Prediabetes or diabetes
• High cholesterol and/or high triglycerides
• Metabolic syndrome or one or more traits of metabolic syndrome, which includes large waist size; high levels of triglycerides; low levels of HDL; high blood pressure; high blood glucose levels or type 2 diabetes

NAFLD can be diagnosed during a routine physical checkup that includes a blood test. This quick guide can help you understand non-alcoholic fatty liver disease – including how it is diagnosed and treated.

Blood tests

A blood test can show increased levels of the liver enzymes alanine transaminase and aspartate transaminase. Any spikes in either of those levels may cause your doctor to suspect NAFLD. Prior to making a final diagnosis your doctor may perform additional blood tests at later dates to compare results. If the enzymes remain elevated, your doctor may recommend one or more imaging tests.

Imaging tests

Imaging tests such as ultrasound, CT scan or MRI can be used to help diagnose NAFLD. An ultrasound of the liver will include a full scan of the stomach area, including the liver from multiple directions. If there is fat around the liver, it will be visible on the ultrasound.

The ultrasound results can help the doctor determine the amount of fat deposits on the liver and how much of the liver is impacted. In addition, your doctor may order a CT scan or MRI of the liver. These imaging tests can provide more detailed images and help determine if any other type of liver damage has occurred.

After your initial diagnosis, the doctor may follow up with annual ultrasounds to see if any changes have occurred. 

Treatment

Although there are no medicines approved to treat NAFLD there are other options that can help reverse the fat buildup in the liver caused by NAFLD. These include:

• Weight loss: Losing 3-5% of your body weight can reduce fat in the liver. Depending on your specific situation, your doctor may suggest that you lose more weight or consider bariatric surgery.
• Physical activity: Movement and physical activity is beneficial to support weight loss and help improve other aspects of metabolic health.
• Control diabetes: Proper management of diabetes is important to reduce the risk of fatty liver disease.
• Manage cholesterol: It is important to keep cholesterol and triglycerides within healthy limits.
• Avoid alcohol: Alcohol can contribute to fat in the liver.

After a few months of treatment, the doctor will check your levels again and work with you to determine if there are additional steps to enhance your liver health.

Nashville General Hospital’s nephrology team can help you better understand NAFLD. To schedule an appointment, visit the NHC Renal webpage or call 615-341-4383.

This information is not intended to be a substitute for professional medical advice. You should talk with your primary care physician or other qualified medical professionals regarding diagnosis and treatment of a health condition.