Non-Alcoholic Fatty Liver Disease (NAFLD): Symptoms, Causes, Risks, Complication, Diagnosis, Treatment, Prevention and Prognosis

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Non-alcoholic fatty liver disease (NAFLD)

1Overview

Located inside the thoracic cavity, the Liver is known to detoxify toxins in the body and also to metabolize the food we ingest. It has two lobes: the Left lobe, which smaller than the right lobe. Behind the liver lies the gallbladder that aids also in the digestion.

Due to the continuing filtering the toxins in the body, the liver is at risk for developing numerous diseases.  In an alcoholic person, there is a risk of developing, alcoholic hepatitis and can develop into liver cirrhosis. There are also non-alcoholic diseases that can be acquired through eating contaminated foods like Hepatitis A and E. Moreover, there are diseases acquired through blood or other bodily secretions like Hepatitis B, hepatitis C, and D.

Although persons who drink little or do not drink alcohol at all may be good, they can also acquire diseases like Non-alcoholic fatty liver disease (NAFLD) is one of them.

Non-alcoholic fatty liver disease, as the term implies, is a condition in which the fats stay within the liver cells called “Fatty liver.” The fatty liver itself is not life threating but can cause problems in the functions of the liver. Non-alcoholic steatohepatitis or NASH, on the other hand, can cause devastating damage to the liver, scarring and inflammation may be present.

2Symptoms

Typically, patients who have the Non-alcoholic fatty liver disease are not experiencing any symptoms. During routine check-up and laboratory tests for other diseases, the NAFLD is discovered. In some cases, the patient may feel discomfort or pain on the upper right quadrant of the abdomen, fatigue while doing activities of daily living, and hepatomegaly (enlargement of the liver).

3Causes

The non-alcoholic fatty liver disease is linked to patients who are obese, have hyperlipidemia and those who have diabetes.

  • Obesity can be a contributing factor in developing nonalcoholic fatty liver.
  • Insulin has a role in synthesizing fats to be converted into energy for consumption and metabolizing chemicals in the liver. Hence, diabetes may cause this type of liver disease.
  • Increase levels of glucose in the blood system is also a cause for this. Not enough supply of insulin in the body can cause an elevation of glucose in the body.
  • Infection in the liver can cause inflammation and scarring of the liver.

4Risk Factors

A great percentage of the population in the Western countries have the non-alcoholic fatty liver disease. Obesity is one of the major contributors in developing the Non-alcoholic fatty liver disease. The excess fats can infiltrate or block the tubes in the liver in through time it can accumulate in the liver, developing a fatty liver.

Non-alcoholic fatty liver disease before was thought as a non-fatal disease, but know it is one of the leading cause of mortality and morbidity in the population. The progression of this disease may lead to more serious illnesses like non-alcoholic steatohepatitis (NASH), cirrhosis, liver cancer and liver failure.

Metabolic syndrome is said to be associated with the Non-alcoholic fatty liver disease. It is a group of factors that can add to the risk of having this disease. Under metabolic syndrome are hypertension, hyperglycemia, and type 2 diabetes, which is insulin dependent.

Other risk factors include:

  • Polycystic ovarian syndrome – This affects over a million of women in the world. It is the imbalance of the hormones estrogen and progesterone that causes cysts inside the ovaries.
  • Hypothyroidism – The thyroid gland is known to control the process of metabolism in the body. If the thyroid is not working properly and not producing the hormone needed the metabolism is impaired.
  • Increased cholesterol levels – Cholesterol has two types –  the Low-Density Lipoprotein (LDL) which causes harmful effects in the body like an accumulation of cholesterol in the arteries that can lead to atherosclerosis.

The second type is the High-Density Lipoprotein (HDL), which can help in lowering the levels of cholesterol in the body by binding with the molecules of the cholesterol and move them to the liver to be synthesized.

  • Geriatrics -As people age, the body can only do much. The decrease in function of the organs can also be a risk of developing a Non-alcoholic fatty liver disease and other illnesses.

5Complications

If left untreated, the Non-alcoholic fatty liver disease will lead to a more serious problem like infection, inflammation and eventually scar the tissue of the liver. Cirrhosis is a common complication brought by this disease. The never ending injury inflicted by the inflammation and healing of the liver causes fibrosis, which is a hardened connective tissue that can interrupt the normal function of the liver. Cirrhosis can lead to many additional problems like:

Esophageal varices

This is the enlargement of blood vessels along the esophagus and the stomach. This happens when the pathway of blood becomes obstructed and can lead to rupture and may lead to profuse bleeding.

Hepatic encephalopathy

This affects the brain function of a patient having serious liver problems. The accumulation of toxins in the body that the liver cannot filter goes into the blood stream and eventually reaches the brain causing an alteration in the consciousness, decrease in the cognitive function, personality changes and even can lead to depression.

Liver Ascites

It is the accumulation of fluid in the abdomen.

Hepatic cancer

There is the rapid development of unhealthy cells in the liver (cancer cells) that can metastasize in the near organs.

Liver failure

This happens when the disease is not treated immediately, and there will be a loss of function of the liver.

6Diagnosis

Physical examination is conducted by the physician, and a series of test will be done to screen whether it is a different disease or a simple fatty liver. The most accurate to determine the status of the liver is a Biopsy.

A sample of the liver tissue will be collected using a small needle, the tissue then will be subjected under a microscope to see if the sample has scarring, infection or has fats.

Another laboratory test can be done to make sure if the diagnosis is correct like:

Blood tests

When aminotransferase and alanine aminotransferase levels are higher than the normal value indicates that the liver is damaged.

Lipid profile

This is used to determine the levels of cholesterol, low-density lipoprotein and high-density lipoprotein in the body.

Fasting blood sugar

The patient is required to not eat 6 to 8 hours before the extraction of blood. This is to determine the level of glucose in the blood.

Test for Hepatitis and Complete blood count

These are done for more basis in diagnosing the patient.

Magnetic Resonance Imaging (MRI)

This allows us to see the liver and its structure if there are any abnormalities in size.

Ultrasound

An ultrasound of the abdomen is done to visualize the liver.

7Treatment

As of today, there are no recommendations for pharmacological management for the Non-alcoholic fatty liver disease, but there are medications that can help treat or manage the predisposing factors leading to NAFLD.

The Statins are the medications given to lower the cholesterol in the body.

  • Atorvastatin
  • Simvastatin
  • Rosuvastatin

Vitamins can help protect the liver, the antioxidant properties of vitamin E neutralize the oxidizing stress occurring in the liver.

Weight loss is a must, decreasing or eliminating the excess fat in the body can help minimize the workload of the liver in breaking down the fats. Surgery can also be an option.

8Prevention

As emphasized about, controlling your weight is one way to prevent liver diseases.

  • Exercising on a weekly basis is good for your health. Jogging and cardio workouts are good in burning fats and toning your lean muscles.
  • Eating healthy foods: preparing your meal is a good practice. It lets you calculate some portions on your plate. Junk foods can be replaced with fruits during snack time.
  • Weigh daily or be conscious of your weight: keep track of your weight, it lets you know if you have to cut back on the carbohydrates and fats.
  • Take vitamins and supplements
  • Drink moderately; there is a certain amount of alcohol that the liver can handle.
  • Don’t take medications that are not prescribed by a doctor. Medication can also be toxic to the liver if not regulated.
  • People who have diabetes, sugar monitoring is needed to control the blood sugar in the body. Maintaining the blood sugar within the normal range will lessen the complication the may happen.
  • Vaccines for Hepatitis is also available. Reducing the risk of acquiring hepatitis is a way to prevent damaging the liver.
  • Have a regular check up with your doctor to keep track of your health, any abnormalities or discrepancies in your health must all be documented and reported to a medical practitioner. Prevention is better than cure.

9Prognosis

People who develop a non-alcoholic fatty liver disease that is not treated or managed immediately have a greater percentage of having complications leading to loss of liver function and eventually mortality.

Further diagnostic procedures and studies must be conducted to help diagnose these diseases accurately. Proper health education must also be disseminated, to help the population be aware of these conditions or illnesses and help them prevent the occurrence and the sudden increase of the population that have the non-alcoholic fatty liver disease.