Non-Alcoholic Fatty Liver Disease (NAFLD): Causes And Symptoms

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Non-Alcoholic Fatty Liver Disease

Non-alcoholic fatty liver disease has been recognized as a silent, yet major, disease in developed countries. It starts with a simple fatty liver and gradually advances to fibrosis. The final stage is cirrhosis and liver failure. The symptoms are vague throughout the stages. But early detection can help reverse a fatty liver.

At this very moment, 25% of the world’s population has a disease with no symptoms. The disease, secretly, affects the second biggest organ in the body – our liver. It’s known as non-alcoholic fatty liver disease (NAFLD) and it’s the most common liver disease in the world now.1 It increases the risk of developing serious medical problems, including heart diseases and even liver failure.

Most of us associate any liver problem with excessive consumption of alcohol. But there are plenty of things that create the same effects as that of alcohol on the liver.

What Is Non-Alcoholic Fatty Liver Disease?

NAFLD occurs when there is an excessive buildup of fat in the liver that is not caused by alcohol. The liver holds a small amount of fat. But, if more than 5–10% of the liver contains fat, it becomes a fatty liver. If not treated, the liver becomes vulnerable to further damage and it gradually develops into other serious issues, including liver failure. People who are diagnosed with NAFLD increase the risk of heart diseases and strokes.

Stages Of Non-Alcoholic Fatty Liver Disease

There are four main stages of the disease. Please note that it takes years for the stages to move into an advanced state.

Stage I: This is known as hepatic steatosis or simple fatty liver. Every liver holds a tiny amount of fat. When the fat content grows above the normal standard, it becomes a fatty liver. Since there are no symptoms at this stage, it remains undiagnosed for a long time until the next stage.

Stage II: Only a few people enter this stage known as non-alcoholic steatohepatitis (NASH). In this, the liver is inflamed and people begin to feel certain symptoms like abdominal pain.

Stage III: When left untreated, NASH can lead to fibrosis. This is when the inflammation causes damage to the liver cells. The liver can still function in this state.

Stage IV: This is an advanced stage known as cirrhosis. When NASH progresses and a lot of healthy liver cells are taken over by fibrosis, cirrhosis occurs. The liver shrinks and there’s a lot of scarring involved. The damages become permanent and it eventually leads to liver cancer or liver failure. Only a few people develop cirrhosis from NASH.

Causes Of Non-Alcoholic Fatty Liver Disease

Causes Of Non-Alcoholic Fatty Liver Disease

There are no concrete reasons why some people get fatty liver and why some don’t. A few experts claim it could run in families, or it could be as side effects of certain medication, or it could be a mix of the following.

1. Obesity Or Being Overweight

75% of obese individuals are at risk of developing a fatty liver

A tiny amount of fat is present in every normal liver. But as you go on putting weight, fat begins to accumulate and it reaches a point where your liver cannot handle the excess fat. Obesity has been found to be the most common reason behind a fatty liver.2If you’re obese and especially carry a lot of weight around the waist, there is a high risk of developing NAFLD. And it doesn’t stop there.

Obesity can amplify certain genetic factors that you carry. One study revealed NAFLD could develop if you are obese and you carry a specific gene known as PNPLA3.3

2. Insulin Resistance And Diabetes

People who have type 2 diabetes are at risk of developing fatty liver. Tracing back type 2 diabetes, you would find out insulin resistance might have played a big role in developing NAFLD. Insulin resistance can lead to a fatty liver by increasing free fatty acids in the blood.45

3. High Levels Of Fat In The Blood

Triglyceride is a type of fat present in the blood. When you eat, fat is either stored or used up. The leftover fat that is not used is converted to triglyceride in the liver. So, if you tend to eat unhealthy amounts of the wrong food, your liver releases larger amounts of triglycerides into the blood. Studies have linked high levels of triglycerides to developing NAFLD. These usually run with high LDL “bad” cholesterol and low HDL “good” cholesterol.6

4. Rapid Weight Loss

There are also a few cases where sometimes losing a lot of weight in a short span of time can lead to fatty liver. This is probably because there is a sudden change in fats and fatty acids in the blood. It could happen when people undergo surgery to reduce weight. For instances in jejunoileal bypass and gastroplasty as well as massive small bowel resection.7

5. High Fructose Consumption

A diet high in fructose is associated with NAFLD. In fact, one study revealed excessive fructose has the same damaging effect as that of alcohol on the liver. Fructose increases the amount of uric acid (normal body waste) in the body. When uric acid reaches an unhealthy level, it creates a risk for diabetes, high blood pressure, and obesity – creating an environment for fatty liver.8

6. Metabolic Syndrome

Studies claim people who have metabolic syndrome are at risk of NAFLD. Metabolic syndrome is a group of medical issues that come out from being overweight and raises the danger of heart diseases and diabetes. The factors are a combination of high triglycerides, low HDL cholesterol, high blood pressure, and high blood sugar levels.910

7. Certain Medications

A few drugs have been linked to the development of NAFLD. Corticosteroids, antidepressants, antiviral drugs, and antipsychotic medications have been found to increase the fat content in the liver.11

Risk Factors Of Non-Alcoholic Fatty Liver Disease

There are a few lesser known causes of NAFLD, or some medical conditions that could aggravate a fatty liver.

  • Sleep apnea
  • Polycystic ovarian disease (PCOD)
  • Viral hepatitis
  • Medical issues that flare up during pregnancy like autoimmune hepatitis
  • Underactive thyroid

Symptoms Of Non-Alcoholic Fatty Liver Disease

Symptoms Of Non-Alcoholic Fatty Liver Disease

Most people with NAFLD feel no symptoms at all, especially in the beginning. You might feel a little discomfort a few times in a span of years. If a simple fatty liver advances to the inflamed stage, you might have the following vague symptoms.

Non-alcoholic fatty liver disease is usually diagnosed when you take tests for other reasons. 

  • Fatigue
  • Sudden weight loss and loss of appetite
  • Upper right abdominal pain
  • Nausea

Advanced stages would have the following signs:

  • Abdominal swelling
  • Yellowish appearance of the skin and eyes (jaundice)
  • Enlarged breasts in men

If you have any of the following symptoms, please get yourself checked immediately, especially if you have family members with the disease. It takes years for one stage to advance to the next. Early detection is the best way to tackle and reverse it.

References   [ + ]

1.Younossi, Zobair M., Aaron B. Koenig, Dinan Abdelatif, Yousef Fazel, Linda Henry, and Mark Wymer. “Global Epidemiology of Non‐Alcoholic Fatty Liver Disease–Meta‐Analytic Assessment of Prevalence, Incidence and Outcomes.” Hepatology (2015)
2.Fabbrini, Elisa, Shelby Sullivan, and Samuel Klein. “Obesity and nonalcoholic fatty liver disease: biochemical, metabolic, and clinical implications.” Hepatology 51, no. 2 (2010): 679-689
3.Stender, Stefan, Julia Kozlitina, Børge G. Nordestgaard, Anne Tybjærg-Hansen, Helen H. Hobbs, and Jonathan C. Cohen. “Adiposity amplifies the genetic risk of fatty liver disease conferred by multiple loci.” Nature Genetics (2017)
4.Utzschneider, Kristina M., and Steven E. Kahn. “The role of insulin resistance in nonalcoholic fatty liver disease.” The Journal of Clinical Endocrinology & Metabolism 91, no. 12 (2006): 4753-4761
5.Firneisz, Gábor. “Non-alcoholic fatty liver disease and type 2 diabetes mellitus: The liver disease of our age?.” (2014)
6, 9.Symptoms & Causes of NAFLD & NASH. The National Institute of Diabetes and Digestive and Kidney Diseases
7.Allard, Johane P. “Other disease associations with non-alcoholic fatty liver disease (NAFLD).” Best Practice & Research Clinical Gastroenterology 16, no. 5 (2002): 783-795
8.Vos, Miriam B., and Joel E. Lavine. “Dietary fructose in nonalcoholic fatty liver disease.” Hepatology 57, no. 6 (2013): 2525-2531
10.Paschos, P., and K. Paletas. “Non alcoholic fatty liver disease and metabolic syndrome.” Hippokratia 13, no. 1 (2009): 9-19
11.Rabinowich, Liane, and Oren Shibolet. “Drug induced steatohepatitis: an uncommon culprit of a common disease.” BioMed research international 2015 (2015)

Disclaimer: The content is purely informative and educational in nature and should not be construed as medical advice. Please use the content only in consultation with an appropriate certified medical or healthcare professional.

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