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​Nonalcoholic Fatty Liver Disease

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To make an appointment with a UPMC liver disease expert, call 412-647-1170 or fill out our contact form.


What Is Nonalcoholic Fatty Liver Disease (NAFLD)?

Fatty liver disease is a condition in which too much fat collects within the liver. Alcoholics are especially at risk for fatty liver disease.

Nonalcoholic fatty liver disease (NAFLD) is when this condition occurs in someone who doesn't drink large amounts of alcohol.

NAFLD affects about 30 percent of people living in the U.S.

Types of NAFLD

There are two types of NAFLD: simple fatty liver disease and nonalcoholic steatohepatitis (NASH).

While people will have fat in the liver with both types, they differ in some major ways.

  • Fatty liver disease. People with this type have little or no swelling of the liver and no liver cell damage. Simple fatty liver disease typically doesn't cause any permanent liver damage.
  • NASH. By contrast, people with NASH will have swelling of the liver and liver cell damage. NASH can cause fibrosis (or scarring) of the liver and may lead to cirrhosis or liver cancer.

Causes of NAFLD

Experts aren't quite sure what causes NAFLD. Research suggests that people are more likely to develop NAFLD if they also have other health conditions.

The most common ones include:

  • Type-2 diabetes.
  • Obesity, especially with a large waist size.
  • Insulin resistance or prediabetes.
  • Metabolic syndrome.
  • High cholesterol (mainly LDL or "bad" cholesterol) or triglyceride levels.
  • High blood pressure.
  • Sleep apnea.
  • Polycystic ovarian disease.

Research suggests that certain genes or having your gallbladder removed may also make you more likely to get NAFLD.

Research also links some drugs — including steroids and synthetic estrogen -- to an increased risk of NAFLD.

NAFLD risk factors and complications

Certain groups of people are more at risk of developing NAFLD.

Some studies have shown that NAFLD:

  • Becomes more common in people over 50.
  • Is more common in men.
  • Affects people with high blood pressure and/or high cholesterol.
  • Occurs more often among people with a Hispanic ethnic background.
  • Is higher among those who drink soft drinks with high-fructose corn syrup.

If left untreated, NAFLD may lead to swelling and scarring (cirrhosis) in the liver. Over time, it may even lead to liver cancer or liver failure.

How to prevent NAFLD

NAFLD is most commonly linked to health conditions related to diet and lifestyle.

To reduce your risk of NAFLD, you can make choices that reduce your chances of developing those health conditions.

  • Maintain a healthy body weight. (A BMI of 25 or more is overweight, while a BMI of 30 or more is obese.)
  • Eat more whole, unprocessed foods — such as whole grains, beans, fruits, and veggies — and strictly limit processed and fatty foods.
  • Limit daily sugar intake, following guidelines from the American Heart Association. Women should eat no more than 100 calories (25 grams or 6 teaspoons) from added sugar daily. Men should limit added sugars to 150 calories (36 grams or 9 teaspoons) daily.
  • Get 30 to 60 minutes of exercise daily. (A brisk walk, swimming, or anything else that raises your heart rate will help.)

You should also reduce or eliminate alcohol, which can also cause fat to build up in the liver.

Why Choose the UPMC Center for Liver Diseases for NAFLD Care?

Our world-renowned liver disease experts:

  • Treat the full range of liver conditions including NAFLD and offer the latest, cutting-edge treatments.
  • Partner with you to provide lifestyle and diet changes, as well as counseling services with mental health experts.
  • Work closely with the UPMC Liver Cancer Center and the UPMC Liver Transplant Program. This allows us to provide you with complete and seamless care for any serious complications from NAFLD.

NAFLD Symptoms and Diagnosis

Most people with NAFLD don't have symptoms in its early stages. Doctors usually discover it because of an abnormal liver function test or during testing for an unrelated health issue.

When NAFLD symptoms do occur, they may include:

  • Fatigue and weakness.
  • Weight loss, loss of appetite, and nausea.
  • Stomach pain.
  • Jaundice (yellowing of the skin and eyes).
  • Itching.
  • Fluid retention or swelling of the legs and belly.
  • Mental confusion.

Diagnosing NAFLD

If your doctor thinks you might have NAFLD, they will order or perform one or more of these tests:

  • Blood tests.
  • Endoscopy (diagnostic and therapeutic).
  • Endoscopic ultrasound and endoscopic retrograde cholangiopancreatography (ERCP).
  • Esophageal variceal banding.
  • Liver biopsy.
  • Non-invasive liver imaging (Fibroscan).
  • Paracentesis.
  • Thoracentesis.
  • Transjugular intrahepatic portosystemic shunt (TIPS).

NAFLD Treatment

For mild cases of NAFLD, the main goal of treatment is to avoid serious problems by preventing the disease from getting worse. For more serious cases of NAFLD, our goal is to restore function to the liver.

Lifestyle changes to treat mild NAFLD

For mild cases of NAFLD, the main treatment at UPMC focuses on addressing the risk factors, like making lifestyle changes.

Lifestyle changes that can help slow the progression of NAFLD include:

  • Staying at a healthy weight.
  • Eating a healthy diet.
  • Exercising routinely.
  • Limiting alcohol intake.
  • Taking only medicines that you need and following the prescribed dosing.

We will work with you on a weight loss regimen and a set of goals to improve the health of your liver.

Treatment options for moderate NAFLD

For moderate cases of NAFLD, your doctor might:

  • Suggest a more rigorous diet or meal replacement plan.
  • Combine lifestyle changes with medications.
  • Regularly check the health of your liver to avoid progression of disease into advanced stages.

Treatment options for severe NAFLD or NASH

For severe cases of NAFLD or NASH, your doctor might:

  • Suggest bariatric surgery if you're obese with advanced NAFLD and struggle with weight loss.
  • Talk to you about a liver transplant if liver scarring is extensive and extremely limits liver function.

To learn more about NAFLD, or to make an appointment at the UPMC Center for Liver Diseases, call 412-647-1170.