Nonalcoholic Fatty Liver Disease

Nonalcoholic Fatty Liver Disease (NAFLD)

The largest organ inside the body is the liver and helps in digesting food, storing energy, and removing toxins. Fatty liver disease is a condition in which fat builds up in your liver. There are two main types of fatty liver –

  • Nonalcoholic fatty liver disease (NAFLD), more serious condition is NASH (Nonalcoholic steatohepatitis)
  • Alcoholic-related fatty liver disease, also called alcoholic steatohepatitis.

Nonalcoholic fatty liver disease (NAFLD) is known as a buildup of fat in the liver that is not caused by alcohol. NAFLD causes the liver to swell and damages it.

The global prevalence of NAFLD is around 25% while statistics report the prevalence to be between 6.7% and 55.1% in India.

NAFLD develops in 4 main stages while most people develop stage 1 without realizing it. The main stages of NAFLD are:

  1. simple fatty liver (steatosis) – harmless build-up of fat in the liver cells
  2. non-alcoholic steatohepatitis (NASH) – a more serious form of NAFLD
  3. fibrosis – persistent inflammation in the liver causes liver injury and scar tissue formation around the liver. Liver function is normal.
  4. cirrhosis – the most severe stage, after years of inflammation – resulting in permanent damage and may lead to liver failure.

What is Nonalcoholic steatohepatitis (NASH)?

Nonalcoholic steatohepatitis (NASH) is a serious form of nonalcoholic fatty liver disease (NAFLD). In NASH, the liver swells from excess fat and inflammation. NASH causes cell damage that further affects the liver function. Over time (usually many years), irreversible liver scarring may happen which will not heal (liver cirrhosis).

What are the symptoms of NAFLD?

There are no symptoms seen in NAFLD, but at more advance stages, the symptoms could be as follows:

  • Tiredness
  • Unexplained feeling of being unwell (malaise).
  • Pain or discomfort in the upper right belly area.

In most advanced stages of NAFLD (cirrhosis), the symptoms may include:

  • Itchy skin.
  • Unexplained weight loss
  • Abdominal swelling
  • Breathlessness
  • Swelling seen in the legs.
  • Spider-like blood vessels just beneath the skin’s surface.
  • Red palms.
  • Yellowing of the skin and eyes, or jaundice.
  • Weakness.

What are the causes and risk factors of NAFLD?

It is not fully known why fat builds up in some livers and not in others, but the following factors may be linked to conversion of NAFLD to NASH:

  • Genetics.
  • Being Overweight or obesity
  • In diabetes or insulin resistance (when cells are unable to take up sugar)
  • High levels of fats, cholesterol, especially triglycerides, in the blood.
  • Certain medications.
  • Over the age of 50
  • Increased risk in underactive thyroid

What are the diagnostic tests for NAFLD?

Generally, NAFLD shows no symptoms and it is often found when tests for other reasons point to liver problems or if a person undergoes routine diagnostic tests and that shows a high level of liver enzymes leading to further testing and diagnosis.

Blood Tests:

Blood tests may not always indicate NAFLD. A blood test called the Liver Function test (LFT) is conducted and its abnormal result and if other conditions such as hepatitis is ruled out, NAFLD is diagnosed.

Imaging tests: Detailed check for the workings of liver, To check for fat deposits in liver.

  • Special ultrasound and MRI scans, and Abdominal computerized tomography (CT) scanning

Liver Biopsy:

  • The only way sure shot way to be certain that fatty liver disease is the only cause of liver damage is with a liver biopsy.
  • A liver biopsy involves getting a tissue sample of your liver with a needle.
  • The needle removes a tiny piece of liver tissue that is seen under a microscope.

What are the treatment options in NAFLD?

Special treatment is not required if only NAFLD without complications is present.

  • Certain lifestyle changes may prevent fat build up or even reverse it. These are as follows:
    • Weight loss: Typically, losing 10% of the body weight can remove some fat from the liver and reduce the presence of NASH. Losing even 3% to 5% of weight can have significant benefits.
    • Healthy diet: A balanced diet high in fruits, vegetables, protein, and carbohydrates, but low in fat, sugar and salt. A doctor might recommend a nutritionist for guided and informed diet needs.
    • Having water instead of sweet drinks
    • Regular Exercise – Atleast 150 minutes of moderate-intensity activity, such as walking or cycling, a week; all types of exercise may help improve NAFLD.
    • Smoking cessation
    • Alcohol – Although not because of alcohol, NAFLD may become worse due to drinking. Avoid drinking in NASH or NAFLD
  • Medications: There are no medicines to manage NAFLD, but accompanying conditions such as high blood pressure, diabetes, high cholesterol should be managed.
  • In people with liver cirrhosis, liver transplant is suggested.

How can I prevent NAFLD?

To reduce your risk of NAFLD:

  • Eat a healthy diet – Rich in fruits, vegetables, whole grains and healthy fats.
  • Limit alcohol, simple sugars and portion sizes
  • Keep a healthy weight.
  • Exercise. Be active most days of the week.


  1. Shalimar, Elhence A, Bansal B, Gupta H, Anand A, Singh TP, Goel A. Prevalence of Non-alcoholic Fatty Liver Disease in India: A Systematic Review and Meta-analysis. J Clin Exp Hepatol. 2022 May-Jun;12(3):818-829.
  2. Alcohol-related liver disease. NHS UK. March 2024.
  3. Non-alcoholic fatty liver disease (NAFLD). Mayo Clinic. March 2024.

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