Health Tips

As modern lives improve, we get to have a huge feast whenever we want; to catch up with our workload amidst endless distractions, we often have to stay up until late night to finish them. Such a lifestyle is no stranger to most people in today’s age, but do you know that it can take a great toll on your liver, the organ that detoxes your body and ensures everything else runs smoothly?

Stages of non-alcoholic fatty liver disease (NAFLD) 

Image credit: Signimu, CC BY-SA 3.0, via Wikimedia Commons

Nonalcoholic fatty liver disease (NAFLD) is increasing rapidly in the Asia-Pacific region, including Malaysia. It is  a very common disorder and refers to a group of conditions where there is accumulation of excess fat in the liver of people who drink little or no alcohol. For people who experience liver damage as a result of habitual drinking, another term is used, called alcoholic fatty liver disease. 

NAFLD develops in 4 main stages, each with different signs and symptoms, treatment requirement and prognosis (i.e. A forecast of the likely outcome):

Stage 1: Fatty liver (steatosis)

The most common form of NAFLD is a non-serious condition called fatty liver. In fatty liver, fat accumulates in the liver cells. As weight gain and obesity become more common, more and more people develop fatty liver. Although having fat in the liver is not normal, by itself it probably does not damage the liver. Most people with fatty liver do not have any symptoms and their liver functions are still considered normal. 

Stage 2: Non-alcoholic steatohepatitis (NASH)

However, as fatty liver worsens, some people may go on to develop a more serious form of  NAFLD known as non-alcoholic steatohepatitis (NASH). In NASH, fat accumulation can result in liver cell inflammation. The exact causes of NASH is not known yet, but it is more commonly seen in people with metabolic syndromes. More on that later.

Stage 3: Fibrosis

Following NASH, the persistent inflammation of liver cells results in different degrees of scarring in the liver tissues and blood vessels. The liver is still able to function properly, but things are not looking good if the condition continues to deteriorate.

Stage 4: Cirrhosis

Cirrhosis occurs when the liver experiences substantial damage after several years, and the liver cells are gradually replaced by scar tissue, which results in the inability of the liver to work properly. Ultimately, liver failure happens and this damage is permanent. Some patients who develop cirrhosis may eventually require a liver transplant. In some cases, people with severe forms of NASH even go on to develop liver cancer.

Fatty liver and insulin resistance: what’s the connection?

The prevailing theory is that fatty liver gets started because of insulin resistance, which is, in turn, frequently a consequence of obesity and excess fat tissue in the abdomen. When people are insulin resistant, their muscle, fat, and liver cells don't respond normally to insulin, so levels of the hormone — and the blood sugar it ushers into cells — build up in the blood. As a result, the risk of developing diabetes and heart disease increases. 

But insulin resistance is a complicated metabolic state that also causes another phenomenon: it increases the amount of free fat molecules called fatty acids circulating in the blood. Those fat molecules often ended up in— you guess it— your liver. Your liver cells start to get inflamed when they are wrapped around in fats, and you know the rest of the story. So really, the key to improve your insulin resistance and liver health is to control your body weight.

What is it like to have non-alcoholic fatty liver disease (NAFLD)?

Most of the time, patients with NAFLD do not have any symptoms. This is why NAFLD is a tricky condition– it is a silent killer that gives no warning signs. Some patients with nonalcoholic NASH (stage 2) may complain of fatigue, general unease, and a vague discomfort in the upper abdomen area. You are likely to discover that you have NAFLD because blood tests revealed an abnormal liver function test or when you have imaging tests of the abdomen for other reasons (such as an ultrasound being done to look for gallstones).

Am I at risk of non-alcoholic fatty liver disease (NAFLD)?

You're at an increased risk of NAFLD if you have: 

• are obese or overweight – particularly if you have a lot of fat around your waist (a “muffin top” body shape). The International Diabetes Federation 2009 defined obesity as waist ≥94 cm in men or ≥80 cm in women. 

• have type 2 diabetes

• have high blood pressure

• have high cholesterol

• have metabolic syndrome (a combination of diabetes, high blood pressure and obesity) 

• are over the age of 50

• smoke

But NAFLD has been diagnosed in people without any of these risk factors, including young children.

Prevention and Treatment

Unfortunately, there is no cure for non-alcoholic fatty liver disease (NAFLD). However, treatment plans are available to salvage loss.The treatment of NAFLD aims to treat the underlying causes, such as obesity, high blood pressure, high cholesterol, diabetes etc. 

1. Weight loss is the key to combating fatty liver

As we have emphasized over and over again, overweight and obesity increase the risks of developing fatty liver. The best thing you can do to help your liver is control your body weight, which improves your insulin sensitivity and ward off fatty liver. But we encourage you to take it steadily, as rapid weight loss can actually worsen your liver disease! 

You may aim for a loss of 0.5-1kg body weight per week by healthy eating and physical activity. Do work with a healthcare professional such as a nutritionist to come up with a weight loss plan that is safe, healthy and sustainable for you. In morbidly obese cases, you may consult specialist on weight loss medications or bariatric surgery. Do not try any weight loss treatment without consulting a healthcare professional.

2. Strictly follow the treatment plans for your other medical conditions

If you have any conditions that we mentioned above, such as diabetes, high blood pressure and high blood cholesterol, ensure they are well-controlled by strictly following the treatment plan prescribed by your doctor. Occasionally, doctors may prescribe insulin sensitizers, such as pioglitazone and liraglutide, to people with NAFLD and diabetes. These are medications that improve the action of insulin produced by the body, which in turns improves NAFLD. Vitamin E has also been shown to provide improvements for people with NAFLD, probably due to its antioxidant properties.

3. Live a healthy lifestyle

A healthy lifestyle includes eating a balanced diet high in fruits, vegetables, protein and carbohydrates, but low in fat, sugar and salt; exercise regularly (aim to do at least 150 minutes of moderate-intensity activity, such as walking or cycling, a week); and stop smoking if you do.

4. Consult your doctor if you need to be vaccinated against hepatitis A and B

The United States of Centers for Disease Control and Prevention (CDC) recommends that individuals with with chronic liver disease (including, but not limited to, persons with cirrhosis, fatty liver disease, alcoholic liver disease, autoimmune hepatitis, or abnormal liver function test) to receive vaccination against Hepatitis A and B. Check with your doctor to see if you need them.

A word from Doc2Us

If you have any questions related to fatty liver, you can consult our professional doctors and healthcare professionals on Doc2Us. Doc2Us is a mobile application that allows you to talk to a doctor or any healthcare professionals via text chat at any time and from anywhere.  For better communication, you can even send our online doctor images or voice messages related to your medical inquiry.

Download Doc2Us app on Apple App Store, Google Play Store and Huawei App Gallery; or use our web chat at https://web.doc2us.com/

Note: Doc2Us is not for medical emergencies. In the event of urgent medical conditions, please call 999.

Disclaimer: As a service to our users and general public, Doc2Us provides health education contents. Please note the date of last review or update on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

References

1. UpToDate - Epidemiology, clinical features, and diagnosis of nonalcoholic fatty liver disease in adults

2. UpToDate - Patient education: Nonalcoholic fatty liver disease (NAFLD), including nonalcoholic steatohepatitis (NASH) (Beyond the Basics)

3. UpToDate - Management of nonalcoholic fatty liver disease in adults

4. NHS UK - Non-alcoholic fatty liver disease (NAFLD)

5. American College of Gastroenterology - Non-alcoholic Fatty Liver Disease (NAFLD)

6. Ma, J., Hwang, S., Pedley, A., Massaro, J., Hoffmann, U., Chung, R., Benjamin, E., Levy, D., Fox, C. and Long, M., 2017. Bi-directional analysis between fatty liver and cardiovascular disease risk factors. Journal of Hepatology, [online] 66(2), pp.390-397. Available at: [Accessed 7 March 2021].

7. Powell, E., Cooksley, W., Hanson, R., Searle, J., Halliday, J. and Powell, W., 1990. The natural history of nonalcoholic steatohepatitis: A follow-up study of forty-two patients for up to 21 years. Hepatology, [online] 11(1), pp.74-80. Available at: [Accessed 7 March 2021].

8. Rinella, M., 2015. Nonalcoholic Fatty Liver Disease. JAMA, [online] 313(22), p.2263. Available at: [Accessed 7 March 2021].

9. MIMS - Nonalcoholic fatty liver disease

10. Harvard Health Publishing - When the liver gets fatty

Cover image credit: https://www.myupchar.com/en, CC BY-SA 4.0 via Wikimedia Commons
 

Written By

Ms Joyce Toh

Reviewed By

Doc2us Medical Board