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By Mary Beth Lemley

Grillo Information Center

Q: I know a couple of people who have been diagnosed with nonalcoholic fatty liver disease. What is this and how is it treated?

A: Nonalcoholic fatty liver disease is the buildup of extra fat in liver cells that is not caused by alcohol consumption.  Excessive alcohol use is a common reason for a fatty liver, so the term NAFLD is reserved for cases not associated with alcohol.

There are two phases of NAFLD: nonalcoholic fatty liver and nonalcoholic steatohepatitis. NAFL is characterized by excess fat in the liver but little or no inflammation or damage to the liver. Most people with this condition have no symptoms. But in a small subset of people with NAFL, the disease progresses to NASH, which is defined by inflammation and damage to the liver.  At this point, some people experience symptoms such as pain and swelling in the upper right abdomen.

The risk of developing NAFLD is higher in people who are obese, diabetic or prediabetic, or have high blood pressure.  This condition is found most frequently in Hispanics followed by non-Hispanic whites and Asian Americans. NAFLD  occurs in children but is most commonly seen in middle age. In the U.S.,10 to 20% of the population have NAFL and 2 to 5% have NASH.

The cause of NAFLD is unknown. Metabolic syndrome (a group of metabolic disorders), diets high in fructose and genetic factors are all being investigated for how they might be involved in causing this condition.

When liver function tests show high levels of liver enzymes in the blood, NAFLD may be suspected. Imaging tests such as ultrasound, MRI or CT scan can be used to get a better look at the liver. Diagnosis is ultimately made by a liver biopsy.

Complications of NAFLD are seen when NASH progresses to even more serious liver damage called cirrhosis. This is permanent scarring of the liver that can eventually lead to liver failure.

There are currently no medications approved to treat NAFLD, but many are being investigated. The current treatment strategy consists of following a healthy diet to maintain a reasonable weight, controlling blood pressure, keeping blood sugar levels in check and managing blood cholesterol and lipid levels. These lifestyle measures may slow, stop or even reverse NAFLD.

Working with a health care provider toward these goals improves the outlook and prognosis for NAFLD. All medications (prescription drugs and over-the-counter products) and nutritional or herbal supplements should be reviewed as they may affect liver function and complicate NAFLD.

Mary Beth Lemley volunteers with the Grillo Center, which offers free, confidential research to assist in health understanding and decisions. To use this service, contact the center at or 303-415-7293. No research or assistance should be interpreted as medical advice. We encourage informed consultation with a health practitioner.

Where to find it

American Liver Foundation

Google: Liver Foundation nafld

Johns Hopkins Medicine

Google: Johns Hopkins nafld

National Institute of Diabetes and Digestive and Kidney Diseases

Google: NIDDK nafld

Cleveland Clinic

Google: Cleveland Clinic health library nafld