Patient education: Nonalcoholic fatty liver disease (The Basics)

What is nonalcoholic fatty liver disease? — Nonalcoholic fatty liver disease, or "NAFLD," is a condition in which fat builds up in the liver. The liver is a big organ in the upper right side of the belly (figure 1).

This condition has 2 forms:

●Nonalcoholic fatty liver, or "NAFL" – In NAFL, the liver has fat buildup, but is not inflamed.

●Nonalcoholic steatohepatitis, or "NASH" – In NASH, the liver has fat buildup and is inflamed.

This article is mostly about NASH, because that is the condition that can lead to the most problems.

People who drink too much alcohol can get a condition similar to NASH. But NASH is not related to drinking too much alcohol.

What causes NASH? — Doctors do not know what causes NASH. They do know that NASH happens more often in some people, such as those who:

●Have excess body weight

●Have diabetes, which causes blood sugar levels to get too high

●Have high cholesterol

●Take certain medicines

What are the symptoms of NASH? — Most people with NASH have no symptoms.

Your doctor or nurse might suspect that you have NASH from the results of your routine blood tests.

Will I need more tests? — Yes. If your doctor or nurse suspects that you have NASH, you will likely have:

●More blood tests

●An imaging test of the liver – This might be an ultrasound, CT, or MRI scan. Imaging tests create pictures of the inside of the body.

Some people need a liver biopsy. During this test, a doctor removes a small sample of tissue from the liver. Then, another doctor looks at the sample under a microscope to see if NASH is present. A liver biopsy is the only test that can tell for sure if you have NASH. Your doctor might do this test if they are not sure if you have NASH or to see how much inflammation is in your liver. If your blood tests and imaging tests are normal, you will not need a liver biopsy.

How is NASH treated? — NASH is not typically treated directly. But it can improve when related medical conditions get treated. For example, losing weight and controlling high blood sugar and cholesterol can help improve NASH.

Your doctor can:

●Help you lose weight, if you have excess body weight – If your doctor recommends losing weight, they can help you make a plan to do this safely. It's important not to lose weight too quickly. Do not lose more than 3.5 pounds (1.6 kilograms) a week.

●Treat your high blood sugar, if you have it

●Treat your high cholesterol, if you have it

Making these changes has benefits besides helping with NASH. These changes can also reduce your chances of having a heart attack or stroke. That's important because people with NASH are often also at risk for heart disease and stroke.

Your doctor might recommend other things, too. For example:

●If you take a medicine that could be causing NASH, your doctor will stop or change that medicine.

●You might get vaccines to protect against hepatitis A and B. These are infections that can harm your liver.

●If you have a severe form of NASH but do not also have diabetes or heart disease, your doctor might suggest that you take vitamin E. A few studies suggest that vitamin E can reduce some of the liver damage that happens as part of NASH. But there are also studies that suggest that high doses of vitamin E increase the risk of death. So do not take vitamin E unless your doctor or nurse recommends it.

Is there anything I can do on my own? — Yes. You can:

●Take all of your medicines as instructed.

●Avoid alcohol. Alcohol can make liver problems worse.

●Eat a healthy diet with plenty of vegetables, fruits, and whole grains.

●Get regular physical activity. Even gentle activity, like walking, is good for your health.

●Go to all of your doctor's appointments.

Does NASH get worse over time? — It might. Sometimes, NASH leads to serious scarring of the liver. This is called "cirrhosis." Cirrhosis can cause different symptoms, such as swelling in the legs, trouble breathing, or feeling tired. If you get cirrhosis, your doctor will talk with you about different possible treatments.

People who have NASH need to see their doctor for regular check-ups. Your doctor will do follow-up tests regularly. These usually include blood tests.

When should I call the doctor? — Call your doctor or nurse if you have symptoms of cirrhosis. These can include:

●Blood in your bowel movements or vomit

●Symptoms of infection, such as fever over 100.4°F (38°C) or chills

●Belly pain

●Swollen legs or ankles

●Trouble breathing

●Extreme tiredness

●Confusion

●Yellowing of the skin or whites of your eyes, called jaundice

More on this topic

Patient education: Weight loss treatments (The Basics)
Patient education: Type 2 diabetes (The Basics)
Patient education: Treatment for type 2 diabetes (The Basics)
Patient education: Liver panel (The Basics)
Patient education: High cholesterol (The Basics)
Patient education: Cirrhosis (The Basics)

Patient education: Nonalcoholic fatty liver disease (NAFLD), including nonalcoholic steatohepatitis (NASH) (Beyond the Basics)
Patient education: Losing weight (Beyond the Basics)
Patient education: Type 2 diabetes: Overview (Beyond the Basics)
Patient education: Type 2 diabetes: Treatment (Beyond the Basics)
Patient education: High cholesterol and lipids (Beyond the Basics)
Patient education: Cirrhosis (Beyond the Basics)