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What is Non-Alcoholic Fatty Liver Disease (NAFLD)?

A fatty liver is the result of the excess fat in liver cells. Fatty tissue slowly builds up in the liver when a person’s diet exceeds the amount of fat his or her body can handle. A person has a fatty liver when fat makes up at least 5% of the liver. ‘Simple’ fatty liver can be a completely benign condition and usually does not lead to liver damage. However, once there is a buildup of ‘simple’ fat, the liver becomes vulnerable to further injury, which may result in inflammation and scarring of the liver.

Fatty Liver DiseaseCanadian Liver Foundation

The most common cause of fatty liver disease is obesity.

Although many people feel they could lose some weight, few would consider themselves obese. A widely-used measure to define “overweight” and “obese” is the Body Mass Index (BMI). A BMI is a calculation based on your height and weight that gives a number that reflects either a healthy or unhealthy weight.

Fatty Liver DiseaseCanadian Liver Foundation
Body Mass Index chart

What is the natural evolution of the disease?
These liver disorders are generally chronic but progressive. Simple presence of fat is what happens with the majority of patients with NAFLD, and most of them have a benign clinical course. However, if left untreated, NAFLD may progress to more advanced disease, such as Non-alcoholic steatohepatitis (NASH),  which may evolve to fibrosis, cirrhosis, and liver cancer (HCC) in a few cases. The disease progression usually takes decades and depends on a combination of genetic and environmental factors.

Fatty Liver DiseaseCanadian Liver Foundation

In general, people with fatty liver disease have no symptoms. However, some people report discomfort in the abdomen at the level of the liver, fatigue, a general feeling of being unwell and vague discomfort.

Fatty Liver DiseaseCanadian Liver Foundation

The treatment of fatty liver disease is related to the cause. At this time, it is not possible to predict which patients will develop NASH. Once there is a buildup of simple fat however, the liver becomes vulnerable to further injury, which may result in liver inflammation and scarring (NASH).

Patients who are obese are advised to achieve a gradual and sustained weight loss through proper nutrition and exercise. Patients with diabetes and high lipids in their blood have to improve their sugar control and lower lipids levels. Usually, a low-fat, low-calorie diet is recommended along with insulin or medications to lower blood sugar in people with diabetes.

For patients with NASH who are not overweight and not diabetic, a low-fat diet is often recommended. It is also recommended that people avoid drinking alcohol since it can cause and contribute to fatty liver disease. Patients with fatty liver disease should see their primary healthcare providers on a regular basis.
Currently, there is no medication proven to effectively treat fatty liver disease.

Fatty Liver DiseaseCanadian Liver Foundation

Fatty Liver Disease and Alpha-1

The risk of liver disease in Alpha-1 increases if the person suffers additional liver injury such as from viral infections (hepatitis A, B or C, or HIV infection), from alcohol abuse, from fat deposition within the liver (fatty liver), from occupational exposures to liver-toxic chemicals or from association with other genetic diseases (e.g., hemochromatosis). 

Alpha-1 Liver DiseaseNational Jewish Health

The Pi*Z variant presented in 13.8% of patients with cirrhotic NAFLD but only in 2.4% of counterparts without liver fibrosis (p<0.0001). Accordingly, the Pi*Z variant increased the risk of NAFLD subjects to develop cirrhosis (adjusted OR=7.3 (95% CI 2.2 to 24.8)). 

Heterozygous carriage of the alpha1-antitrypsin Pi*Z variant increases the risk to develop liver cirrhosisBMJ Journal