Non Alcoholic Fatty Liver Disease (NAFLD)

Non-alcoholic fatty liver disease (NAFLD), also known as metabolic dysfunction-associated steatotic liver disease (MASLD), is one of the most common chronic liver diseases in the world, affecting up to 25% of the global population. The condition is when fat makes up more than 5-10% of the liver weight and there is no heavy alcohol use, and it can progress from simple fatty liver (NAFL) to non-alcoholic steatohepatitis (NASH) with inflammation and damage. Risk factors include obesity, type 2 diabetes, high cholesterol and metabolic syndrome.

Signs of illness

Most people with NAFLD do not have any symptoms at first. The most common symptoms are fatigue, discomfort in the upper right abdomen, and mild pain. Jaundice, leg swelling, loss of appetite, nausea, itching and confusion can occur with advanced NASH or cirrhosis. This diagram shows the spectrum of NAFLD from steatosis to cirrhosis, with the risk of progression.

Aetiology and Diagnosis

Insulin resistance, which is potentiated by oxidative stress and lipotoxicity, causes fat accumulation. The diagnosis is made by ultrasound, blood tests for liver enzymes, or a biopsy for confirmation.

Management
No specific drugs: focus on lifestyle. 7-10% weight loss via diet and exercise reverses early stages. Control diabetes and lipids; monitor for fibrosis/transplant in advanced cases.