Nonalcoholic Fatty Liver Disease and NASH: Symptoms, Treatment


Nonalcoholic fatty liver disease (NAFLD) is an umbrella term for a range of conditions in which excess fat accumulates in your liver. This buildup is not caused by heavy alcohol use. If heavy alcohol use leads to the buildup, the condition is called alcoholic liver disease. NAFLD can be divided into two separate conditions:

  • Simple fatty liver, also called nonalcoholic fatty liver (NAFL)

People with simple fatty liver only have an accumulation of fat in their liver. Little or no inflammation or liver cell damage is found. Generally, it doesn’t cause further damage or complications.

  • Nonalcoholic steatohepatitis (NASH)

Different from NAFL, nonalcoholic steatohepatitis involves not only buildup of fat, but also inflammation of the liver and liver cell damage, which may lead to fibrosis, or scarring of the liver. If the condition gets worse, it can progress to cirrhosis and liver failure.

People typically develop one of these two types, though some people with one type may be later diagnosed with the other one.

The number of people suffering from NAFLD keeps rising, especially in Western nations. As the most common form of liver disease, NAFLD affects about 80 to 100 million people in the United States.


Nonalcoholic fatty liver usually has few or no signs or symptoms. If symptoms do occur, they may include:

  • Enlarged liver
  • Fatigue
  • Pain in the upper right abdomen

Nonalcoholic steatohepatitis and cirrhosis may have symptoms such as:

  • Abdominal swelling
  • Enlarged blood vessels just beneath the skin’s surface
  • Enlarged breasts in men
  • Enlarged spleen
  • Red palms
  • Yellowing of the skin and eyes (jaundice)


The exact cause of NAFLD and NASH is still under research. It remains unclear why some people accumulate fat in the liver and why some fatty livers develop inflammation. But nonalcoholic fatty liver disease and nonalcoholic steatohepatitis both have an association with:

  • Overweight or obesity
  • Insulin resistance
  • High blood sugar (hyperglycemia)
  • High levels of fats, particularly triglycerides, in the blood

Risk factors

You may be at a higher risk of getting NAFLD if you have:

  • High cholesterol
  • High levels of triglycerides in the blood
  • Metabolic syndrome
  • Obesity, particularly when fat is concentrated in the abdomen
  • Polycystic ovary syndrome
  • Sleep apnea
  • Type 2 diabetes
  • Underactive thyroid (hypothyroidism)
  • Underactive pituitary gland (hypopituitarism)

The following groups are more likely to develop nonalcoholic steatohepatitis:

  • Older people
  • People with diabetes
  • People with body fat concentrated in the abdomen


In most cases, the nonalcoholic fatty liver disease causes few or no symptoms. Therefore, it is usually noticed when a liver problem is found during tests for other conditions. Tests used to diagnose NAFLD include:

Blood tests

Imaging procedures

  • Plain ultrasound
  • Computerized tomography (CT) scanning or magnetic resonance imaging (MRI)
  • Transient elastography
  • Magnetic resonance elastography

Liver tissue examination

If the doctor is not able to make a diagnosis with other tests, a liver biopsy may be needed. A sample of tissue from your liver will be removed and then examined in a laboratory to look for signs of inflammation and scarring.


Weight loss through a healthy diet and exercises will be recommended to treat nonalcoholic fatty liver disease and nonalcoholic steatohepatitis.

Losing weight can reduce the fat in your liver so that the conditions contributing to NAFLD will be addressed. Although you may need to lose 10 percent of your body weight, a loss of three to 5 percent of starting weight will significantly improve your condition. It should be noted that an extremely rapid weight loss through fasting will make the condition worse instead. You have to lose your weight gradually in healthy ways.


In order to lower your risk of nonalcoholic fatty liver disease, you can:

  • Choose a healthy diet
  • Maintain a healthy weight
  • Exercise

Keywords: nonalcoholic fatty liver disease; nonalcoholic steatohepatitis.

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* The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.