Fatty Liver Disease (Non-Alcoholic)

Non-alcoholic fatty liver disease (NAFLD) is a condition of the liver that is characterized by fat accumulation (also known as steatosis) in the liver, occurring in individuals who consume little or no alcohol (equal to or less than two drinks per day in men and one drink per day in women). NAFLD is currently thought to be the most common type of liver disease in both adults and adolescents in the U.S. with rates of up to 25-30% of the U.S. population. At the Fatty Liver Disease Clinic, part of the University of Michigan’s Hepatology Program, we provide the latest diagnostic and treatment options to patients with non-alcoholic fatty liver disease, as well as access to new therapies through our clinical trials. Our dedicated dietician works individually with patients to help them achieve weight loss and diet modification to both improve insulin resistance and prevent progression of the disease. And through MHealthy—U-M’s health and well-being services—we offer specialized programs aimed at reducing the risk of NAFLD.

Categories of Non-Alcoholic Fatty Liver Disease

Non-alcoholic fatty liver disease can be separated into two main categories:

  • Simple steatosis: The presence of fat in the liver without much inflammation or scarring (fibrosis).
  • Non-alcoholic steatohepatitis (NASH): Fat along with inflammation and varying amounts of scarring (fibrosis).

For some patients, non-alcoholic fatty liver disease can lead to cirrhosis (excess scarring) of the liver and complications of cirrhosis, including liver failure and primary liver cancer (hepatocellular carcinoma). Patients with non-alcoholic steatohepatitis are particularly at risk of their liver disease progressing over time to cirrhosis and its complications. NASH is now considered to be the second leading cause of primary liver cancer. Patients with non-alcoholic fatty liver disease also appear to be at higher-than-usual risk for cardiovascular disease, including hardening of the arteries (atherosclerosis). This is important to keep in mind as managing NAFLD might decrease the risk of developing future cardiovascular disease.

Who’s at Risk for Non-Alcoholic Fatty Liver Disease?

The three most common risk factors for non-alcoholic fatty liver disease are:

  • Obesity
  • Hyperlipidemia (high blood cholesterol levels, especially high triglycerides)
  • Diabetes

Certain medications and some surgical procedures, such as intestinal bypass surgery, can also lead to NAFLD. Additionally, there are associations with other medical conditions, such as sleep apnea.

Non-Alcoholic Fatty Liver Disease Symptoms

Most patients do not have any symptoms even when the liver is badly damaged. If patients do have symptoms, they include:

  • Tenderness in the upper right side of abdomen
  • Fatigue

Non-Alcoholic Fatty Liver Disease Diagnosis

Patients with non-alcoholic fatty liver disease usually present with unexplained elevations of liver enzymes, which are detected with blood tests. Ultrasound, CT scan or MRI may also be used to diagnose NAFLD. The standard for determining the severity of NAFLD is a liver biopsy. A liver biopsy is usually an outpatient procedure and involves inserting a needle through the skin and obtaining a sample of liver tissue to see how much damage there is in the liver. Liver biopsy can also differentiate between simple steatosis and non-alcoholic steatohepatitis, as well as provide information on the degree of scarring. All other forms of chronic liver disease are excluded when a diagnosis of NAFLD is made. However, fatty liver is seen in other liver diseases, especially viral hepatitis, such as hepatitis C.

Non-Alcoholic Fatty Liver Disease Treatment

The main treatment of non-alcoholic fatty liver disease involves trying to improve underlying risk factors, such as obesity, diabetes, and abnormal lipid levels. This includes: Lifestyle Changes: These can include weight loss and physical exercise, such as aerobic training or resistance exercise. Diet: Food that is rich in fiber and low in processed or easily absorbable sugars, and higher in complex carbohydrates, is recommended. Additionally, diet should be low in saturated fats and with more polyunsaturated fat. Our certified dietician is available for consultation with patients. Medications: Several medications have been and/or are currently being investigated for treatment of NAFLD, especially for those with non-alcoholic steatohepatitis. Recently, it has been recommended to consider using the natural form of vitamin E in patients with liver biopsy showing evidence of non-alcoholic steatohepatitis.

Other Information About Digestive and Liver Health

To see related medical services we offer, visit our Digestive and Liver Health overview page.

Make an Appointment

To discuss concerns or questions about fatty liver disease, schedule an appointment by calling us toll-free at 844-233-0433.