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Non-alcoholic fatty liver disease (NAFLD)

> What are the causes of NAFLD?

> What are the symptoms of NAFLD?

> How is NAFLD diagnosed?

> How is NAFLD treated?

> How to prevent NAFLD?

> FAQ

Until recently, liver diseases were mainly thought to be associated with excessive alcohol intake or viral inflammation of this organ. Alcohol still remains an important problem that causes considerable damage to this organ but studies have begun to shed a new light on also other factors that are associated with an unhealthy lifestyle. Therefore, a new disease has been defined and classified as a disease of affluence – non-alcoholic fatty liver disease. It is also often referred to by its abbreviation NAFLD and refers to fattening of the liver that results from other causes than alcohol-related.

It is estimated that already every fourth adult person may be affected by that disease. On the global scale, as much as one billion people are estimated to live with NAFLD! 1

 

ALCOHOL REMAINS A SERIOUS PROBLEM CAUSING SIGNIFICANT DAMAGE TO THIS ORGAN

What are the causes of NAFLD?

Although NAFLD is already classified as a disease of affluence and is generally recognised as a serious health hazard, its relationship to metabolic dysfunctions remains largely unknown. An international scientific panel has recently suggested a change of the disease name from “non-alcoholic fatty liver disease” (NAFLD) to “metabolic-associated fatty liver disease” (MAFLD), so as to reflect better the metabolic background of this disorder. 2

Research studies on factors that cause NAFLD are still on-going but it is already known that they can be divided into genetic and external ones. The best known risk factors for NAFLD are:

Obesity

NAFLD affects 70-90% of obese persons 3

Type 2 diabetes

NAFLD is present in every second diabetes patient 3

Pre-diabetes (insulin resistance and elevated blood sugar level)

Hepatitis and accumulation of lipids are considered to be the main factors that cause insulin resistance in the course of NAFLD 4

Hypertension

NAFLD may affect up to 70% of persons with arterial hypertension 5

What are the symptoms of NAFLD?

The symptoms usually associated with non-alcoholic fatty liver disease are:

Weakness, fatigue

Malaise

Sleep disorders

Inability to focus

Lack of appetite

Pain in the right subcostal region 6

How is NAFLD diagnosed?

NAFLD is diagnosed on the basis of a clinical interview, laboratory test results and imaging examinations. A confirmation of diagnosis is the result of a histological examination – liver biopsy.1 In the diagnostic work-up, it is very important to rule out other causes of fatty liver such as excessive alcohol consumption and other chronic diseases of the liver. 7

 In the assessment of advancement of hepatic tissue fibrosis in the course of NAFLD, it can be helpful to use certain non-invasive diagnostic tests, e.g. the NFS that analyses 6 factors: age, BMI, laboratory test results: blood glucose, AST and ALT, blood platelet count, albumin level.1,7

How is NAFLD treated?

The first line of treatment usually includes:

Weight loss

It is desirable to lose 10% of the body weight at a rate of 1kg per week, but an improvement is observed when the weight is reduced by on ly 3-5% from the initial level7

Diet

Its purpose is to improve NAFLD and reduce the risk of the development of metabolic disorders that accompany NAFLD. A low-calorie diet with a 30% reduction of food calorie content is recommended3

Physical activity

Areduction of fat content in the liver as a result of regular exercise has been demonstrated. Moreover, physical activity reduces the risk of metabolic disorders that accompany NAFLD: diabetes and obesity3

How to prevent NAFLD?

In NAFLD prevention you should concentrate mainly on having a healthy lifestyle and eating habits: 

Well-balanced diet6

Preferably, a diet without an excessive amount of simple sugars and saturated fatty acids should be used. The principles of the Mediterranean diet may be followed in preparation of daily meals; this diet contains plenty of vegetables, wholemeal products and olive oil. You should avoid glucose fructose syrup contained in sugary drinks and confectionery products.

Regular physical activity 3

Introduce regular physical activity into your daily routine. Intense exercise such as running has been proven to be more beneficial than moderate-intensity exercise such as walking.

Body weight normalization 3

Reduce your daily calorie intake to lose weight. This approach may improve laboratory indicators of your liver health (aminotransferases).

FAQ

  • The following 3 disease stages are distinguished:7

    1. simple fatty liver disease (NAFLD)

    2. non-alcoholic steatohepatitis (NASH)

    3. hepatic cirrhosis

  • It is our lifestyle that is largely responsible for the development of NAFLD. By changing dietary habits and increasing physical activity, which translates into weight loss, you can positively influence the condition of your liver. Reduced fat content in the liver as a result of physical activity has been demonstrated. It has also been evidenced that weight loss has a positive effect on aminotransferase levels in laboratory tests, and a >10% weight loss in most patients leads to a remission (reversal) of NAFLD. 3

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Phospholipids (Essentiale Forte P) 10s

CLINICAL PARTICULARS
Indications
Nutritional support in the management of damaged liver (due to chronic liver disease, liver cirrhosis, fatty liver & intoxication by hepatotoxic substances). Each hard gelatin capsule contains: De-oiled enriched phospholipids from soya-beans …………… 300 mg

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Phospholipids (Essentiale Forte P) 50s

CLINICAL PARTICULARS
Indications
Nutritional support in the management of damaged liver (due to chronic liver disease, liver cirrhosis, fatty liver & intoxication by hepatotoxic substances). Each hard gelatin capsule contains: De-oiled enriched phospholipids from soya-beans …………… 300 mg

Read more

Learn more about the most common liver diseases

Non-alcoholic fatty liver disease (NAFLD)

NAFLD, named new epidemic of the 21st century, is caused by factors other than excessive alcohol consumption.


 

Alcoholic liver disease

The prevalence of liver diseases is clearly linked to drinking habits – when alcohol is consumed regularly and in excess, the liver is doomed to fail.

 

Hepatitis B and C

Viral hepatitis B (HBV) and C (HCV) are the most common viruses in Poland causing acute or chronic hepatitis.
 

 

Cirrhosis

Some causes of cirrhosis of the liver can be classified as external - they have to do with our lifestyle or treatment that causes irreversible liver damage.

 

Autoimmune hepatitis

Autoimmune diseases can be compared to self-sabotage – it is a situation in which your body starts attacking its own tissues. In AIH, the immune system attacks hepatocytes, which are liver cells.

Drug-induced liver injury

The mechanisms for the development of DILI are not fully understood, but it is most likely that the disease is the result of an interaction between the substance and the individual factors of the person.
 

    1. Perumpail, B. J., Khan, M. A., Yoo, E. R., Cholankeril, G., Kim, D., & Ahmed, A. (2017). Clinical epidemiology and disease burden of nonalcoholic fatty liver disease. World Journal of Gastroenterology, 23(47), 8263–8276

    2. Shiha, G. et al. Redefining fatty liver disease: an international patient perspective. The Lancet Gastroenterology & Hepatology; VOL 6, ISSUE 1, P73-79, JANUARY 01, 2021

    3. Gietka J. Klapaczyński J., Stłuszczenie wątroby - diagnostyka i leczenie, https://podyplomie.pl/medycyna/23439,stluszczenie-watroby-diagnostyka-i-leczenie, accessed on: 29/03/2019.

    4. Gruben N., Shiri-Sverdlov R., P.Y. Koonen D., Hofker M.H., Nonalcoholic fatty liver disease: A main driver of insulin resistance or a dangerous liaison? https://www.sciencedirect.com/science/article/pii/S0925443914002579?via%3Dihub accessed on: 09/02/2021

    5. Gavril et al. Relationship between NAFLD and hypertension in patients with type 2 diabetes mellitus; J Hypertens Res (2017) 3(2):44–49

    6. Sterczyński R. Leczenie niealkoholowej stłuszczeniowej choroby wątroby: kluczowa jest zmiana diety Puls Medycyny https://pulsmedycyny.pl/leczenie-niealkoholowej-stluszczeniowej-choroby-watroby-kluczowa-jest-zmiana-diety-982340 accessed on: 12/05/2021

    7. Strzeszyński Ł. Rozpoznawanie i leczenie niealkoholowej stłuszczeniowej choroby wątroby; Medycyna Praktyczna Gastrologia www.mp.pl/gastrologia/wytyczne/80328,rozpoznawanie-i-leczenie-niealkoholowej-stluszczeniowej-choroby-watroby accessed on: 12/05/2021