Nonalcoholic Fatty Liver Disease Affects One in Four American Adults

Have you ever heard of a condition called nonalcoholic fatty liver disease (NAFLD)? If you haven’t, it’s not surprising—it rarely causes symptoms, and it’s not a condition that shows up on routine examinations. But concerns about NAFLD are growing since experts have learned that it’s a risk factor for cardiovascular disease, as well as cirrhosis and liver cancer.

“NAFLD is a disease where there is extra fat in the liver that is not due to other causes (including alcohol). This disease can range from just the presence of fat in the liver (without any damage to the liver cells) to fat with inflammation and/or breakdown of liver cells to the development of scar tissue (fibrosis) and, ultimately, cirrhosis,” explains Sonal Kumar, MD, MPH, Director of Clinical Hepatology at Weill Cornell Medicine.

Symptoms and Diagnosis

“Most of the time, NAFLD is asymptomatic, though some people do describe a vague, right-sided abdominal pain where the liver is,” says Dr. Kumar. “And there are currently no screening guidelines for NAFLD in the general population— which makes it a very underdiagnosed condition. It’s estimated that about 25 percent of the American population has NAFLD.”

So how does your doctor find out you have NAFLD?

“Often, fat in the liver is seen incidentally on imaging, such as an ultrasound or magnetic resonance imaging of the abdomen,” explains Dr. Kumar. In other words, the screening test is focused on another organ, such as the stomach or the small intestine, but the results reveal abnormalities in the liver.

“NAFLD also may be diagnosed after blood work reveals abnormal results on liver tests. But other causes of liver disease, such as hepatitis C, have to be ruled out before a diagnosis of NAFLD is reached,” explains Dr. Kumar.

Risk Factors and Causes

At this time, knowledge about NAFLD is limited.

“The development of NAFLD is thought to begin with dietary, environmental, and genetic risk factors that cause fat to be deposited with the liver,” explains Dr. Kumar. “The known risk factors for NAFLD include obesity, diabetes, and high cholesterol.”

Other conditions linked to a higher incidence of NAFLD include sleep apnea, underactive thyroid (hypothyroidism), and underactive pituitary gland (hypopituitarism).

Possible Consequences

The damage caused by NAFLD builds gradually over many years.

“The most common cause of complications from NAFLD is actually cardiovascular disease (CVD). NAFLD is an independent risk factor for events such as heart attack. No matter how severe the liver disease is, people have to be conscious of the increased risk of heart disease,” says Dr. Kumar. “People with NAFLD are also at risk for the development of cirrhosis that can lead to liver cancer or the need for liver transplant.”

Weight Loss Is the Best Medicine

Dr. Kumar says that, at this time, no medications or medical procedures are approved for the treatment of NAFLD. “However, we do know that, for people who are overweight or obese, losing even just 10 percent of body weight will improve NAFLD in the majority of patients,” she reports.

Researchers who reviewed and analyzed the findings of 43 previous studies found that, among people with NAFLD, weight loss resulted in a significant reduction in several biomarkers of liver disease and liver inflammation. The study findings were published in the journal Metabolism—Clinical and Experimental in February 2021.

“We also recommend following a Mediterranean-style diet if you have NAFLD—it has been shown to help reduce the fat in the liver more than other diets,” notes Dr. Kumar.

The Mediterranean-style diet is rich in whole plant foods. It contains moderate amounts of fish, eggs, and dairy, and minimal red meat and sweets. And it is free from heavily processed food products that typically are high in sodium, added sugars, refined grains, and saturated fat.

Projections for the Future

Unfortunately, NAFLD is expected be a growing health concern in the U.S.

“The numbers for NAFLD are projected to grow due to the rising incidence of obesity and diabetes, as well as increases in awareness and testing,” explains Dr. Kumar. “But a lot of research is currently underway, and we anticipate that further investigations will improve our knowledge about NAFLD and lead us to effective solutions for treatment and prevention.”

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