Causes and risk factors
The exact cause for the development of NFALD is not yet known. It is thought to occur as a result of disturbances in fat metabolism. NFALD is frequently associated with other metabolic disorders like diabetes, hypertension, obesity, hypertriglyceridaemia or PCOS.
Depending upon the progression of the disease, Nonalcoholic fatty liver disease can be divided into 4 types:
- Hepatic steatosis (Simple fatty liver) – Here only excessive fat deposition takes place in the liver
- Nonalcoholic steatohepatitis – In this stage, excessive fat accumulation is associated with inflammation of the liver.
- Fibrosis – In this phase, scar tissue formation takes place.
- Cirrhosis of the liver – Most of the normal liver tissue is replaced by fibrosis.
Clinical presentation
Most patients with NFALD remain asymptomatic. The diagnosis frequently happens accidentally or as a result of investigations for unrelated conditions.
Occasionally patients may experience unexplained fatigue or pain in the right portion of the abdomen.
Simple fatty liver and nonalcoholic steatohepatitis can be reversed with lifestyle correction. However if the condition progresses to cirrhosis, it may eventually be fatal.
Diagnosis & Investigations
Non-alcoholic fatty liver disease must be differentiated from alcoholic fatty liver disease, cirrhosis, autoimmune hepatitis, viral hepatitis and Wilson’s disease.
On physical examination, the doctor will detect a mild hepatomegaly (enlargement of the liver).
Liver function tests will elicit elevated enzyme levels. Imaging studies – USG/CT scan or MRI scan of the abdomen are performed. A liver biopsy may be indicated.
Treatment
Certain lifestyle changes are recommended to the patient. The intake of dietary fats is to be restricted. Physical activity is encouraged to improve metabolism. Patients are advised to lose any excess weight.
Anti-lipid and anti diabetic drugs are prescribed if necessary.
Bariatic surgery can be offered to patients who are morbidly obese.
