Non-Alcoholic Fatty Liver Disease (NAFLD)
Fatty liver (steatosis, non-alcoholic fatty liver disease) is a condition where the liver becomes infiltrated with fat. The fat is called steatosis, but when there is inflammation or scarring, it is called steatohepatitis or NASH.
Non-Alcoholic Steatohepatitis (NASH)
Nash, as mentioned above, means there is a presence of hepatic steatosis and inflammation with hepatocyte injury (ballooning) with or without fibrosis. This can progress to fibrosis, cirrhosis, liver failure and liver cancer. Up to 20% of the US population has fatty liver, and perhaps as many as 5% have NASH.
Non-Alcoholic Fatty Liver Disease (NAFLD) Spectrum
Most people with fatty liver are overweight or have diabetes or pre-diabetes (insulin resistance). Occasionally, medications can lead to fatty liver. Excessive alcohol use can also lead to steatosis.
Fatty liver is a silent condition. Although liver enzymes (AST and ALT) can be elevated, patients generally feel fine. Some complain of a dull pain under their right rib cage, and this is due to swelling of the liver. Usually blood tests lead to the diagnosis. Many people need to get imaging done which includes options like ultrasound, ultrasound elastography or Fibroscan.
Blood tests indicating elevated liver enzymes usually lead to further evaluation. An ultrasound usually shows fat in the liver, but so will a CT scan or MRI scan.
A new ultrasound-based machine called Fibroscan (transient elastography) can diagnose fatty liver and determine the presence of liver scarring. The test is simple, does not expose you to radiation and takes a couple of minutes. If you have risk factors for fatty liver such as obesity, type 2 diabetes, high lipid levels, or significant alcohol consumption; consider getting the Fibroscan test done to assess the health of your liver.
If the results from the Fibroscan show significant scarring then a liver biopsy is still the gold standard to diagnosis steatohepatitis (NASH).
FibroScan is an easy and convenient option to stage liver disease.
There is no FDA approved treatment for NASH, but general therapies include weight loss, control of diabetes, a healthy diet, and abstinence from alcohol. There are some new experimental therapies for fatty liver.
Fatty liver is the most common liver condition in the US. The aggressive variant is called NASH and should not be ignored. It can lead to cirrhosis!