What is NAFLD?

NAFLD i.e. non alcoholic fatty liver disease is a medical condition, in which the fat content of the liver is increased. This causes damage to liver cells and their death. Further, the function of liver is disturbed, and it becomes increasingly stiff or fibrosed (cirrhosis)

Usually, such a degeneration of liver is seen in chronic alcoholics. However, NAFLD constitutes a group of patients who do not consume a significant amount of alcohol, and still exhibit similar changes in liver. Hence the name, non alcoholic fatty liver disease.

What are the causes of NAFLD?

NAFLD is a lifestyle disease. It has been postulated that sedentary lifestyle, obesity, and increased consumption of refined sugar based foods(Junk foods) lead to excess deposition of fat in the liver. This fat is the excess of what body actually can utilise. Slowly, the normal liver cells die and the liver starts getting stiffer and stiffer.

What are the symptoms of this disease?

Obesity and other lifestyle diseases have always been called ‘silent killer’. The same holds true with NAFLD. NAFLD is usually asymptomatic, though the patients may sometimes present with non specific, chronic abdominal pain, on the right side, which often increases with posture.

Your physician may suspect NAFLD on the basis of other contributory factors life the patient being overweight or obese, family history of obesity or diabetes mellitus, high triglycerides etc. The doctor may find an enlarged liver during abdominal examination.

How do we diagnose NAFLD?

Weight records, body mass index, Waist Hip Ratio, demonstrating obesity aid the diagnosis of NAFLD.

Your physician shall order certain blood tests to assess the function of liver. These tests usually demonstrate mild liver dysfunction.Ultrasonography is a common investigation for diagnosis. It can demonstrate increased fat in the liver and even increased liver stiffness. Special ultrasound machienes like fibroscan (transient elastography), can also demonstrate liver fat and stiffness.

There are blood tests based on liver enzymes and platelet counts which also reflect the degree of scarring. A liver biopsy may be required to ascertain the extent of liver damage in a very few select cases.

Are there any other causes of fat in the liver?

Apart from NAFLD and alcohol, your physician may be interested in ruling out other causes of liver dysfunction and increase in liver fat like viral hepatitis, especially hepatitis c, wilson’s disease, and other genetic disorders like glycogen storage disorders.

Does this disease affect children?

Yes. It affects children, mainly those with obesity. Incidentally diagnosed NAFLD in non-obese children occurs most commonly in children in the age group of around 10-15years.

Important causes of fatty liver in infants is metabolic liver disease like glycogen storage disorders, tyrosinemia etc.

What are the diseases which may be associated with NAFLD?

Apart from metabolic syndrome and obesity, other disorders that may be associated with NAFLD include:

• Polycystic ovarian syndrome

• Hypothyroidism

• Obstructive sleep apnea

• Hypopitutarism

• Hypogonadism

• Pancreato-duodenal resection

What are the complications of this disease?

Reduction of liver function and liver failure is the obvious outcome of this disease. The spectrum of liver damage can vary from reversible increase in fat content of the liver to irreversible changes causing a stiff liver (cirrhosis) with markedly reduced function. The latter may require a liver transplant also.

NAFLD is a part of a syndrome called METABOLIC SYNDROME. This signifies the presence of abnormalities in the body’s ability to handle sugars and fats. This can lead to development of diabeties mellitus and hypertriglyceridemia in adulthood.

Hence, diagnosis and intervention at an earlier age can prevent or delay development of these diseases in the adulthood.

Are there any tests to identify underlying metabolic syndrome?

Yes. Your doctor might order some blood tests for the same. These include levels of sugars, insulin, triglycerides in blood.

What is NASH?

NASH or non alcoholic steato-hepatitis is a condition that occurs when the fat deposition increases and causes damage to liver cells. Due to the fat deposition, inflammation of liver takes place. This inflammation causes fibrosis or stiffness of the liver. This stage of the disease is called NASH.

This is irreversible. The stiffness of the liver causes signs and symptomsof liver failure and may herald transplantation of liver.

What is the treatment of this disease?

Lifestyle changes are cornerstone for control and management of this disease.

Regular aerobic exercise, weight control is very important. In the initial stages, these lifestyle changes can reverse the disease process and cure the disease without any other intervention.

Diet modification aids in weight loss and in limiting the progression on the underlying metabolic syndrome. Limiting the intake of refined JUNK and deep fried foods and increasing intake of fibre rich foods like fresh whole fruits and vegetables is desired, instead of preserved fruits or fruit juices.

Vitamin E supplementation has been proven to have good outcomes in adults with this disease. However, it is yet to be validated in children.

If the disease has progressed to cirrhosis, then these interventions may not lead to complete reversibility and cure. However, lifestyle modification still halts/ slows the progression of the disease.

Does the disease run in families?

Yes, it may. Children whose parents are diabetic/ overweight tend to be overweight themselves and are predisposed to metabolic syndrome and hence NAFLD.

Hence healthy eating and lifestyle habits of the family have additive influence over the child, preventing NAFLD.

Important articles on NAFLD

1. Pediatric non alcoholic fatty liver disease: old and new concepts on development, progression, metabolic insight and potential treatment targets. Giorgio et al. BMC Pediatrics 2013, 13:40

http://www.biomedcentral.com/1471-2431/13/40

1. Non-alcoholic fatty liver disease and childhood obesity.

Mathur P, Das MK, Arora NK.

Indian J Pediatr. 2007 Apr;74(4):401-7. Review.

http://www.ncbi.nlm.nih.gov/pubmed/17476088

1. Genetics of nonalcoholic Fatty liver disease: an overview.

Puppala J, Siddapuram SP, Akka J, Munshi A.

J Genet Genomics. 2013 Jan 20;40(1):15-22. doi: 10.1016/j.jgg.2012.12.001. Epub 2012 Dec 26. Review.

http://www.ncbi.nlm.nih.gov/pubmed/23357341

1. Childhood obesity: Determinants, evaluation, and prevention.

Moutusi Raychaudhuri and Debmalya Sanyal. Indian J Endocrinol Metab. 2012 Dec; 16(Suppl 2): S192–S194

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3603024/

1. Body mass index in school-aged children and the risk of routinely diagnosed non-alcoholic fatty liver disease in adulthood: a prospective study based on the Copenhagen School Health Records Register.

Zimmermann E, et al. BMJ Open 2015;5:e006998. doi:10.1136/bmjopen-2014-006998

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4420949/pdf/bmjopen-2014-006998.pdf