Nonalcoholic fatty liver disease (NAFLD) is emerging as one of the widely prevalent liver diseases in the modern world, particularly in developed and developing countries. NAFLD, unlike alcoholic liver disease, is common in individuals who consume limited to zero alcohol but have large amounts of fat stored in the liver.

The rates of nonalcoholic fatty liver are on the rise with the increasing incidences of obesity and sedentary lifestyles, even in younger populations. For NEET PG students and applicants, learning about NAFLD is not merely an exam requirement; it is also crucial for future clinical practice. 

Keep reading for a detailed insight. 

What is NAFLD?

NAFLD represents a spectrum of disorders that have the presence of hepatic steatosis (fatty liver) in individuals who do not consume alcohol or do so in small quantities (less than 20 g of ethanol/week). NAFLD has become the most common cause of chronic liver disease.

It is classified into 2 major types as per the table below:

Type	Description
NAFL (Simple Steatosis)	The liver has fat buildup, but it is not accompanied by inflammation or fibrosis.
NASH (Nonalcoholic Steatohepatitis)	Fat, inflammation, and cellular damage of the liver. May develop into a condition that causes fibrosis or cirrhosis.

Without treatment, NASH can develop into non-alcoholic liver cirrhosis, hepatocellular carcinoma, or end-stage liver disease.

What are the Causes and Risk Factors of NAFLD?

A single factor does not cause NAFLD, but there is a strong correlation between it and metabolic health. Obesity and metabolic syndrome (a group of diseases characterised by high blood sugar and high blood fats) are also significant concerns. 

Causes of NAFLD

In practice, NAFLD is often caused by or seen with:

• Obesity and Insulin Resistance: The excess body fat (particularly in the abdominal area) and the inability of cells to respond to insulin result in the accumulation of fat in the liver.
• Type 2 Diabetes or Prediabetes: Increased blood sugar facilitates fatty liver development.
• High Cholesterol or Triglycerides: Pathologic levels of lipids increase the likelihood of fatty liver.
• Genetics and Family History: Having relatives with fatty liver or obesity can increase your risk. There are genetic factors which incline some individuals.
• Other Medical Conditions: Polycystic ovary syndrome (PCOS), obstructive sleep apnea, and underactive thyroid (hypothyroidism) or pituitary have the potential to increase the risk of NAFLD.
• Age and Ethnic Background: NAFLD develops more frequently in individuals beyond the age of 50 and may vary across different populations.
  

Some of these risks have been identified to overlap with what is referred to as metabolic syndrome (high blood pressure, large waist, differentiating lipids, excessive levels of glucose). Metabolic syndrome also raises the risk of NAFLD by a significant factor. Nevertheless, others can obtain NAFLD without apparent risk factors. 

Other Contributing Risk Factors of NAFLD

• Sedentary lifestyle
• High sugar and fructose intake
• Certain medications (e.g., amiodarone, tamoxifen, corticosteroids)

Understanding these risk factors is essential to identifying and managing non-alcoholic fatty liver disease early.

What are the Symptoms of NAFLD?

Non-alcoholic fatty liver symptoms are often mild or absent at first. The majority of individuals with early-stage NAFLD are unaware of their illness since the condition is diagnosed chiefly during regular check-ups or scans. 

Symptoms can develop and may include:

• Fatigue or general malaise (feeling tired).
• Pain and discomfort in the upper right side of the abdomen – a dull ache under the ribs, around the location of the liver.
• Unexplained weight loss or weakness (less common).

In severe stages (NASH or cirrhosis), there may be more severe symptoms that include yellow skin or eyes due to jaundice, itchy skin, or a hard belly due to fluid (ascites), swollen legs, or confusion (hepatic encephalopathy).

What is the Diagnosis of NAFLD?

The identification of NAFLD requires the elimination of other liver illness causes and the confirmation of fat in the liver. NAFLD often has no symptoms, so it is commonly detected when liver enzymes are elevated during routine blood testing. 

Typical steps to diagnose NAFLD include:

• Medical History and Exam: The doctor will ask about alcohol use (to confirm it’s “nonalcoholic”) and look for signs of liver enlargement.
• Blood Tests: Liver enzyme tests and other laboratory tests are used to assess the liver’s functioning. They do tests for viral hepatitis or autoimmune liver disease to rule out other types. Diabetes or lipid panel tests can also be undertaken.
• Imaging: The initial imaging study is typically an abdominal ultrasound, which may reveal a bright (“fatty”) liver. 

Other imaging modalities, including CT (computed tomography) and MRI (magnetic resonance imaging), as well as specialised elastography scans, can provide more specific measurements of liver fat or stiffness.

• Liver Biopsy: To confirm the severity in ambiguous cases, a needle can be used to remove a small portion of liver tissue. The most reliable method for distinguishing NAFLD and NASH (i.e., whether there is inflammation or fibrosis) is biopsy.

The diagnosis of NAFLD depends on the appearance of fat on ultrasound in a person with no significant alcohol consumption and an existing risk factor. In cases where the liver enzyme is elevated, or imaging is not precise, a biopsy can confirm the presence or absence of NASH (non-alcoholic steatohepatitis, or inflammation).

What are the Treatment Options for NAFLD?

There is no FDA-approved drug specifically for nonalcoholic fatty liver disease yet, but lifestyle considerations can be highly effective, such as:

1. Lifestyle Modifications

• Weight Loss: A 7–10% reduction in body weight can reverse steatosis and even improve fibrosis.
• Diet: The Mediterranean diet (low in sugar, high in fibre and omega-3) is recommended.
• Exercise: At least 150 minutes per week of moderate aerobic activity.
  

2. Medications (Off-label Use)

• Pioglitazone: It may be considered for biopsy-proven NASH in diabetics.
• Vitamin E (800 IU per day): For non-diabetic NASH patients.
• GLP-1 analogues (e.g., liraglutide): Show promise in weight loss and NAFLD improvement.
• Metformin: Not directly effective for NAFLD but beneficial in diabetic patients.
  

3. Surgical Options

• Bariatric surgery may be considered in morbidly obese patients unresponsive to lifestyle changes.

FAQs About NAFLD

1. Can NAFLD develop in people with a normal weight?

Yes, this is referred to as “lean NAFLD.” It’s more common in specific populations like South Asians and is often linked to visceral fat and insulin resistance.

2. How is NAFLD different from alcoholic liver disease?

Both cause fatty changes in the liver, but non-alcoholic fatty liver disease develops in people who do not consume harmful levels of alcohol. The liver pathology may look similar, but the aetiology differs.

3. Does NAFLD always progress to cirrhosis?

No. Simple non-alcoholic fatty liver may remain stable or even regress with lifestyle changes. Only a subset of patients with NASH may develop non-alcoholic liver cirrhosis.

4. What foods should I avoid if I have NAFLD?

Here are the foods that you must consume in limitation:

• Fructose-rich foods (soft drinks, processed snacks)
• Saturated fats (red meat, butter)
• Excessive carbohydrates
  

5. Can NAFLD be reversed?

Yes. With sustained weight loss and metabolic control, non-alcoholic fatty liver disease-especially the simple steatosis type-can often be reversed.

Conclusion

Nonalcoholic fatty liver disease has long-term risks if left untreated. Therefore, it is important to focus on recognising risk factors, utilising non-invasive diagnostics, and implementing lifestyle-based treatments. Also, it is essential to know how to interpret FibroScan, liver enzymes, and NAFLD scoring tools.

For NEET PG aspirants, it’s essential to differentiate non-alcoholic fatty liver symptoms from other causes of hepatomegaly and transaminitis. 

Platforms like DocTutorials are designed to support your learning with concise video lectures, focused quick revision programs (QRPs), and well-structured high-yield notes tailored for both exam success and clinical readiness.

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