Non-alcoholic fatty liver disease (NAFLD)

Simple fatty liver (steatosis)

80% of people with NAFLD have simple fatty liver and will not develop serious liver problems.

Non-alcoholic steatohepatitis (NASH)

20% of people with NAFLD have a more serious form called NASH. NASH is different from simple fatty liver because the liver is also inflamed. This form of NAFLD can lead to fibrosis (scarring) around the liver and nearby blood vessels. Whilst the liver can still function normally in the early stages of this process, eventually cirrhosis may develop where the liver shrinks and becomes scarred and lumpy. This damage is permanent and can lead to liver failure as well as liver cancer.

Further assessment and treatment in a hospital setting may be needed for people who develop NASH.

Importantly, people with NAFLD also have an increased risk of developing other problems e.g. heart attacks, strokes, chronic kidney disease (CKD). The risks for these can also be reduced by changes to lifestyle.

As mentioned above, NAFLD is usually discovered as a coincidental finding during tests arranged for other reasons. However, once identified it is important to assess the risk of a patient developing NASH and cirrhosis. This is done by putting your results into an algorithm which can predict your risk. Your GP will usually need your age, BMI and blood test results to do this. Any action taken will depend on your risk score.

Most patients can be managed by their GP, but some will need further tests and referral to a liver specialist. Your GP will be able to advise if this is needed.

People diagnosed with NAFLD can usually lead a normal life. Identifying and managing NAFLD early can lower the level of fat in your liver and prevent the condition from worsening.

You can help to prevent NAFLD or stop it from progressing as rapidly by making healthy lifestyle changes.

The following changes will reduce your risk of developing further problems:

Weight loss

• Many cases of fatty liver are linked to being overweight or obese. Only rarely is it related to medications or to genetic diseases.
• You should aim for a Body Mass Index of 18 –24.9 (use the BMI calculator to work out your Body Mass Index). However, you should avoid very rapid weight loss as this can actually cause NAFLD due to rapid changes of fat levels in the blood

Exercise

• Aim to do at least 150 minutes of moderate intensity activity such as walking or cycling each week. This can help improve NAFLD even if you do not lose weight. Click here for further information.

Healthy Diet

• Aim to reduce cholesterol (a risk factor for developing NAFLD).
• Try to have a balanced diet high in fruit and vegetables but low in fat, sugar and salt.
• Smaller portions can help with weight loss.

Minimal or no alcohol intake

• It is advised that you avoid alcohol if you have NAFLD, although very occasional alcohol is thought unlikely to be harmful. The maximum limit should be less than 14 units per week for both men and women. Regular alcohol consumption may make NAFLD worse.

Treatment of associated conditions and risk factors

• These include type 2 diabetes, high cholesterol and high blood pressure. The lifestyle management for all these conditions is the same as that for liver disease.

Stop smoking

• If you smoke, stopping will improve your overall health and reduce your risk of many other health problems.
• You can speak to an NHS stop smoking service if you think you may need help quitting. They can provide support and if necessary, prescribe stop smoking treatments.
• Follow the link to 10 self help tips to stop smoking.

You can get help and advice about making lifestyle changes by clicking here.

Click here to view a Patient information leaflet about NAFLD – Developed by University Hospitals Plymouth

The British Liver Trust publish guides and factsheets on a range of liver diseases. All their patient information is written by medical specialists in their field or other health care professionals. Please follow the link to the library of patient guides.

The British Liver Trust have provided a useful guide which covers three key areas where you can ‘Love Your Liver‘ and help it function at its best. Follow the link to read about the three simple steps you can take to better liver health.

Love your liver in 3 simple steps | British Liver Trust

British Liver Trust | Published 17 September 2015

Liver good life | British Liver Trust & Jazzy de Lisser

British Liver Trust | Published 18 May 2009

Lover your liver – a British Liver Trust campaign | British Liver Trust

British Liver Trust| Published 20 August 2018