Non-alcoholic fatty liver disease (NAFLD) occurs when a large amount of fat – that isn’t associated with heavy alcohol use – accumulates in the liver (5-10% by weight). In its mildest form, this disease doesn’t cause much trouble, presenting with few (if any) symptoms and complications. NAFLD affects 20-30% of North Americans, but can be treated with lifestyle changes.


Non-Alcoholic Steatohepatitis

While NAFLD is mostly benign, left unaddressed it can develop into a much more harmful disease-state called non-alcoholic steatohepatitis (NASH), which involves inflammation of the liver. NASH affects 20% of those with NAFLD.1 It occurs when scar tissue (fibrosis) is visible in the liver. Fibrosis can develop into advanced scarring (cirrhosis) or liver cancer. About 20% of those diagnosed with NASH develop cirrhosis, which is a serious problem that can lead to many complications.2 In 2008 and 2009, 12% of British patients waiting for a liver transplant had cirrhosis caused by NASH.5 It can even be deadly: a recent study found that 11% of patients with NASH are at risk of death from liver-related illness.4


A Symptom of Metabolic Syndrome

Metabolic syndrome is a condition defined by an increase in blood pressure, blood sugar, and/or cholesterol, as well as having excess abdominal fat. NAFLD is so common in individuals with this illness that some researchers believe it is the hepatic manifestation of metabolic syndrome and should become part of the diagnostic criteria. They even suggest the usefulness of ultrasonically-detected NAFLD as a diagnostic tool for metabolic syndrome.3 Having other disorders associated with metabolic syndrome may also make your NAFLD more dangerous. One study found that individuals who had NAFLD along with type 2 diabetes were more likely to die from liver disease than those without diabetes.4 If you are concerned you may have any of these ailments, talk to your physician about being tested.


What Did Your Mother Eat?

Most new mothers are aware that specific habits during pregnancy, such as tobacco and alcohol consumption, can have a powerful effect on the health of the child. However, the type of food mothers eat can also cause issues. A recent study showed that the children of women who ate a high-fat diet while pregnant were more likely to develop NAFLD when they got older. While the exact mechanism responsible for this is unclear, the researchers have an idea. They believe that most people develop NAFLD in a two-step process. The first step is hepatic insulin resistance or impaired β-oxidation of fatty acids, the second step is inflammation or oxidative stress. The researchers speculate that children who are exposed to high amounts of fatty acids in utero experience this first step before birth, so that all it takes for them to develop NAFLD is some sort of inflammation or oxidative stress. However, pregnant women may be able to prevent this by reducing the overall quantity of fats in their diets and eating more omega-3 fatty acids.1


NAFLD is Treatable

Although the statistics for this disease are significant, the good thing is that it is treatable. Many studies have looked at possible treatments for NAFLD, and the overarching theme is that treating with diet and exercise, usually to achieve weight loss, is very effective. However, it is important for patients to avoid any drastic weight loss methods; starvation, protein deficiency, and rapid weight loss can cause or worsen NAFLD.2 This is why it is important to follow a healthy regimen to treat NAFLD, rather than opting for surgeries or programs that offer rapid weight loss.5 Consult your general practitioner or a registered dietitian to learn about the right treatment for you.

First published in the Inside Tract® newsletter issue 192 – 2014
1. Hughes AN et al. A lipid-rich gestational diet predisposes offspring to non-alcoholic fatty liver disease: a potential sequence of events. Hepatic Medicine: Evidence and Research. 2014;6:15-23.
2. Canadian Liver Foundation. Fatty Liver Disease. Available at: Accessed 2014-09-18.
3. Tarantino G et al. What about non-alcoholic fatty liver disease as a new criterion to define metabolic syndrome. World Journal of Gastroenterology. 2013;19(22):3375-84.
4. Stepanova M et al. Predictors of All-Cause Mortality and Liver-Related Mortality in Patients with Non-Alcoholic Fatty Liver Disease (NAFLD). Digestive Diseases and Sciences. 2013;58:3017-23.
5. Bradford V et al. Lifestyle interventions for the treatment of non-alcoholic fatty liver disease. Hepatic Medicine: Evidence and Research. 2014;6:1-10.