Nonalcoholic fatty liver disease(NAFLD)

Nonalcoholic fatty liver disease(NAFLD) is a leading cause of chronic liver diseases globally. NAFLD is a medical condition in which excess fat deposits in the liver. This deposition of fat is not caused by heavy alcohol use.

NAFLD affects about 25% of the global adult population ranging from 13.5% in Africa to 31.8% in the Middle East. The prevalence of NAFLD in India is about 9% to 32%.

NAFLD can be classified into two sub categories: nonalcoholic fatty liver or simple fatty liver (NAFL) and nonalcoholic steatohepatitis (NASH).

  • Simple fatty liver-In this condition, fat is deposited in the liver without any inflammation and liver damage and does not progress to cause complications.
  • Nonalcoholic steatohepatitis (NASH)- In this condition, in addition to fat deposits, inflammation of liver cells is there which can cause fibrosis, or scarring of the liver and can lead to cirrhosis or liver cancer. 

NAFLD can affect people of any age, including children. Several factors contribute to the development of NAFLD such as family history of NAFLD or metabolic syndrome and environmental modifiers such as diet, lifestyle, presence of obesity, diabetes, hypertension, and dyslipidemia.

Know more about:

Operational guidelines for the integration of Non-alcoholic fatty liver disease (NAFLD) in to NPCDCS by MoHFW, GOI- can be accessed from https://main.mohfw.gov.in/newshighlights-42

National Program for Prevention and Control of Cancer, Diabetes, CVD and Stroke (NPCDCS)

National Multisectoral Action Plan (NMAP) for Prevention and Control of Common NCDs (2017-22)

References-

https://pubmed.ncbi.nlm.nih.gov/30335697/

https://main.mohfw.gov.in/newshighlights-42

https://www.niddk.nih.gov/health-information/liver-disease/nafld-nash/definition-facts

Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) are silent diseases, usually show few or no symptoms. Symptoms may be in the form of tiredness and discomfort in upper right side of abdomen.

References-

https://main.mohfw.gov.in/newshighlights-42

https://www.niddk.nih.gov/health-information/liver-disease/nafld-nash/symptoms-causes

 

NAFLD is more common in people who have following conditions

  • Overweight or obesity
  • Insulin resistance
  • Abnormal levels of lipid profile

o   High levels of triglyceride

o   Abnormal levels of cholesterol

§  High total cholesterol

§  High LDL cholesterol

§  Low HDL cholesterol

  • Metabolic syndrome

o   Large waist size

o   High levels of triglyceride

o   Low HDL cholesterol

o   High blood pressure

o   Higher than normal blood glucose

  • Type 2 diabetes
  • Hypothyroidism
  • Certain genes may be responsible for NAFLD

Less common causes

  • Rapid weight loss
  • Infections such as hepatitis C
  • Certain medicines-amiodarone, diltiazem, glucocorticoids, methotrexate, synthetic estrogens, tamoxifen, valproic acid

References-

https://main.mohfw.gov.in/newshighlights-42

https://www.niddk.nih.gov/health-information/liver-disease/nafld-nash/symptoms-causes

Early detection of NAFLD is useful to identify those with potentially silent progressive fatty liver disease. Diagnostic practice for NAFLD includes medical history, clinical, biochemical and radiographic tests.

Medical history for:

  • Overweight or obesity
  • Abnormal levels of lipid profile
  • Metabolic syndrome
  • Type2 diabetes
  • Information about lifestyle factors such a physical activity, diet- eating a diet high in sugar and starch, and alcohol intake

Physical exam: During a physical exam weight and height is checked to calculate body mass index and medical care provider will look for other signs of NAFLD such as- enlarged liver, jaundice etc.

Investigations include:

Blood tests-

  • Liver function tests and lipid profile, but routine liver tests do not rule out NAFLD
  • Noninvasive Biomarkers such as Fibrosis -4 Index (FIB-4) and NAFLD Fibrosis Score (NFS)

Imaging tests-

  • Ultrasound
  • Computerized tomography(CT) scans
  • Magnetic resonance imaging

Liver biopsy: Though liver biopsy is a confirmatory test for NAFLD diagnosis but not recommended to everyone with NAFLD as it is invasive and expensive. 

References:

https://main.mohfw.gov.in/newshighlights-42

https://www.niddk.nih.gov/health-information/liver-disease/nafld-nash/diagnosis

 

Lifestyle intervention plays an important role in the management of NAFLD. Calorie restriction and physical activity with weight loss are crucial ways in lifestyle intervention. Both aerobic and resistance exercises with a reduction in intake of simple sugars, industrial fructose, and saturated fats are essential for weight management.

New studies suggest that foods rich in monosaturated fatty acids like nuts, almonds, cashews, eggs may be more beneficial than a low fat diet.

Advise of weight loss can reduce fat in the liver, inflammation, and fibrosis. No medicines have been approved to treat NAFLD but various medicines can be useful in managing the problems associated with the condition.

People with NAFLD who drink alcohol should be aware of the importance of staying within the recommended limits for alcohol consumption.

Bariatric surgery-In patients unresponsive to lifestyle changes and pharmacotherapy, bariatric surgery is an option for reducing weight and metabolic complications.

References-

https://main.mohfw.gov.in/newshighlights-42

https://www.bmj.com/content/372/bmj.m4747

https://www.niddk.nih.gov/health-information/liver-disease/nafld-nash/treatment

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6092580/

 

Simple fatty liver is more common form of NAFLD and it does not develop complications. Though NASH can lead to cirrhosis and liver cancer. People with NAFLD have a greater chance of developing cardiovascular diseases.

Reference-

https://main.mohfw.gov.in/newshighlights-42

 

Healthy lifestyle is the cornerstone for the prevention and management of NAFLD. 

Choose a healthy diet: Choose a healthy diet that's rich in fruits, vegetables, whole grains and healthy fats, and limiting portion size.

  • Replacing saturated fats and trans fats in your diet with monounsaturated fats and polyunsaturated fats, especially omega-3 fatty acids.
    • (Saturated fats-found in meat, poultry skin, butter, lard, shortening, and milk and dairy products)
    • Trans fats are hydrogenated or partially hydrogenated oils used in commercially baked goods such as cookies and cakes, and fried foods such as doughnuts and French fries
    • Monounsaturated fats are found in olive, peanut, and canola oils
    • Polyunsaturated fats are found in corn, soybean, and safflower oils, and many types of nuts.)
  • Eat more foods with low-glycemic index such as fruits, vegetables, and whole grains. Whereas white bread, white rice, and potatoes are foods with high glycemic index.

(The glycemic index is a value assigned to foods based on how slowly or how quickly those foods cause increases in blood glucose levels)

  • Avoid foods and drinks that contain large amount of simple sugars.
  • Avoid heavy alcohol use 

Maintain a healthy weight. If you are overweight or obese reduce your weight by reducing the number of calories you eat each day and doing more exercise. If you have a healthy weight, work to maintain it by choosing a healthy diet and exercising.

Exercise: If you are not exercising regularly consult your medical care provider first and make your exercise plan for most days of the week.

References-

https://main.mohfw.gov.in/newshighlights-42

 https://www.niddk.nih.gov/health-information/liver-disease/nafld-nash/eating-diet-nutrition

 

  • PUBLISHED DATE : Apr 04, 2021
  • PUBLISHED BY : NHP Admin
  • CREATED / VALIDATED BY : Dr. Aruna Rastogi
  • LAST UPDATED ON : Apr 04, 2021

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