Non-alcoholic fatty liver disease (NAFLD) is a term used to describe a range of conditions caused by a build-up of fat in the liver. According to the NHS, around one in three UK adults have early-stage NAFLD.
NAFLD is associated with an increased risk of various health conditions like diabetes, stroke, and heart attack. And, if fat continues to build, it can lead to liver damage.
Luckily, whether or not you have NAFLD, there are plenty of ways to look after your liver health, reduce your risk of NAFLD, and prevent the condition from progressing. There’s also evidence that lifestyle changes like losing weight and staying active may be able to reverse early-stage NAFLD.
Here, we’ll explore everything you need to know about NAFLD.
What is non-alcoholic fatty liver disease?
The liver sits on the upper-right side of the abdomen and is the body’s largest internal organ. Its main function is to process food nutrients and remove toxins from the blood. Blood travels from the digestive system to the liver to be filtered before travelling elsewhere in the body.
A healthy liver should contain little to no fat. Non-alcoholic fatty liver disease (NAFLD) is caused by a build-up of excess fat in liver cells. If fat accounts for more than 10% of the liver’s weight, this is considered fatty liver disease.
Note: There’s also alcohol-related fatty liver disease (ARLD). However, while the two conditions are similar, NAFLD isn’t caused by drinking too much alcohol. In this article, we’ll focus mainly on NAFLD. However, you can read more about ARLD on the NHS website.
What are the different stages of non-alcoholic fatty liver disease?
If left unchecked, non-alcoholic fatty liver disease (NAFLD) can progress and lead to more serious liver damage.
According to the NHS, NAFLD develops in four main stages…
- Simple fatty liver (steatosis) – a small build-up of fat in liver cells that’s largely harmless and will likely only be diagnosed during tests for something else.
- Non-alcoholic steatohepatitis (NASH) – this is a more serious stage of NAFLD, where the liver becomes inflamed. According to the NHS, around 5% of the UK population is affected by NASH.
- Fibrosis – persistent inflammation that causes scar tissue to develop around the liver and nearby blood vessels. However, the liver is still able to function properly.
- Cirrhosis – the most serious stage of NAFLD, which occurs due to long-term inflammation. This causes the liver to shrink and become lumpy and scarred. Unfortunately, this damage is permanent and increases the risk of liver failure and liver cancer.
The majority of people with fatty liver disease will remain in the first stage, usually without any symptoms.
In some cases, if left untreated, the condition can progress and cause liver damage. However, fibrosis and cirrhosis can take years to develop, so making lifestyle changes can help.
What are the symptoms of non-alcoholic fatty liver disease?
It’s common for people to experience no symptoms in the early stages of NAFLD.
However, in more advanced stages (NASH or fibrosis), common symptoms can include…
- Fatigue
- A dull or aching pain in the top right area of your stomach (around the lower right side of the ribcage)
- Weakness
- Unexplained weight loss
Cirrhosis (the most advanced stage of NAFLD) can cause more severe symptoms, including itchy skin, loss of appetite, yellowing of the skin and eyes (jaundice), and swelling in the feet, ankles, legs, or stomach.
What are the risk factors for non-alcoholic fatty liver disease?
NAFLD can affect anyone. However, several factors can increase your risk. These include…
- Being overweight or obese – particularly if you carry a lot of fat around your midsection.
- Type 2 diabetes
- High cholesterol
- High blood pressure
- Age – being over 50 increases your risk
- Smoking
How is non-alcoholic fatty liver disease diagnosed?
NAFLD is most commonly diagnosed by a blood test known as a liver function test. If it produces an abnormal result and other liver conditions, such as hepatitis, have been ruled out, you may be diagnosed with NAFLD. That said, blood tests aren’t always accurate at picking up the condition.
NAFLD may also be spotted during an ultrasound scan of your stomach.
Once you’ve been diagnosed with NAFLD, you may need to have further tests to determine what stage the condition is at. This may involve an ultrasound scan, blood tests, or a biopsy.
You can find out more about how NAFLD is diagnosed on the NHS website.
How is non-alcoholic fatty liver disease treated?
The majority of people with NAFLD won’t develop any serious complications. However, if you’re diagnosed, it’s worth taking steps to manage the condition and prevent it from progressing. This includes making healthy lifestyle changes, which we’ll cover in the next section.
In some cases, treatment may also be recommended for people with conditions that are known to exacerbate NAFLD, such as diabetes, high blood pressure, or high cholesterol levels. You’ll likely also be advised to have regular check-ups with your GP to keep an eye on the condition.
To read more about treatment for NAFLD, head over to the NHS website.
6 ways to reduce your risk of non-alcoholic fatty liver disease
The most effective way to reduce your risk of NAFLD and prevent it from progressing is by making healthy lifestyle changes. For example, experts suggest that things like eating a healthy diet, being physically active, and losing weight can slow or even reverse early-stage NAFLD.
We’ll cover some of these below.
Note: While NAFLD isn’t caused by alcohol, drinking may make it worse. As a result, experts advise either cutting down or avoiding alcohol entirely.
1. Maintain a healthy weight
Being overweight or obese is considered the greatest risk factor for fatty liver disease, therefore experts agree that weight loss is key to preventing complications.
This study found that in people who are overweight, losing 10% of their body weight may help to reduce liver fat, lower inflammation, and improve scarring. Another scientific review concluded that weight loss caused by lifestyle changes, medication, or weight-loss surgery can successfully treat later-stage NAFLD.
There are plenty of ways to achieve weight loss goals in a healthy, sustainable way. For example, by lowering your intake of salt and added sugar and being more active. We’ll cover these weight loss tools and many more in greater detail below.
2. Eat a healthy, balanced diet
Generally speaking, experts recommend that people with NAFLD follow a whole-food-based diet high in protein, fibre, and unsaturated fats. This is because whole foods tend to be high in vitamins, minerals, and antioxidants that help to fight inflammation and reduce the risk of disease.
For example, research has linked diets high in legumes, whole grains, and fibre-rich foods with a lower risk of NAFLD.
Specifically, research has found that the plant compounds in spinach and other leafy green vegetables may help to fight fatty liver disease. And omega-3 rich foods, such as salmon and walnuts, are believed to benefit people with NAFLD by reducing liver fat, lowering triglyceride levels, and boosting HDL (good) cholesterol levels.
More generally, diets based around whole, plant-based, nutritionally-dense foods have been consistently linked with healthy weight loss.
If you’re unsure how to go about applying this advice, the Mediterranean diet is a good place to start.
3. Make exercise a regular part of your routine
Staying active is key to reducing your risk of NAFLD and preventing the condition from progressing.
One reason for this is because exercise contributes to healthy weight loss. However, being physically active is also linked with a reduced risk of diabetes, high cholesterol, and high blood pressure, which are also linked to NAFLD.
Research has found that frequent exercise can reduce the risk of NAFLD by 16% and improve the remission rate by 40%.
Another study found that when people performed a moderate exercise routine (20-60 minutes, four to seven days a week, including both aerobic exercise and resistance training) with or without dietary changes, their risk of developing later-stage NAFLD significantly decreased.
Meanwhile, other studies have shown that many NAFLD patients had low activity levels.
For ideas on how to be more active, head over to the fitness and exercise section of our website. Here, you’ll find information on everything from cycling, running, team sports, and creative ways to increase your daily step count. Or why not sign up to a virtual fitness class on Rest Less Events?
4. Take steps to manage associated health conditions
Health conditions like type 2 diabetes, high cholesterol, and high blood pressure are all risk factors for NAFLD. So, taking steps to manage these conditions, for example, by lowering your blood sugar levels, is important.
One reason for this is that the majority of cholesterol from food ends up in the liver. As a result, this study found that NAFLD patients benefited from lowering their cholesterol levels.
For further guidance, check out our guide to type 2 diabetes and our articles; 5 tips to help lower cholesterol and 10 natural ways to lower blood pressure.
5. Drink more water
There’s evidence that increasing your water intake may effectively reduce the risk of NAFLD.
In this study, drinking more water was found to help lower body weight, reduce calorie intake, and burn more body fat. Because these factors are all linked with NAFLD-related health conditions, experts have suggested that drinking more water may lower the risk of NAFLD.
Staying hydrated is also important for liver health because it helps to keep blood thinner and easier for the liver to filter. It also reduces the risk of constipation, which places excess strain on the liver and kidneys.
If you struggle to drink enough water, you might find our article, 10 tips for staying hydrated and why it’s important, useful.
6. Quit smoking
Quitting smoking is important for general health – particularly if you have a liver condition.
Smoking is a known risk factor for NAFLD and has been found to exacerbate all types of liver disease, and increase the risk of liver cancer. In this study, smoking cigarettes was found to accelerate the progression of NAFLD.
Another study, which linked smoking to NAFLD, found that, when we smoke, nicotine gathers in the intestine and activates a specific protein called AMPK. This sets off a chain of chemical reactions that cause ceramides and lipids to increase in the liver, and NAFLD to progress.
The NHS offers stop smoking services if you’d like support with quitting.
Final thoughts…
NAFLD is a common condition that, if left untreated, can pose further health risks. Luckily, there are steps you can take to reduce your risk and prevent NAFLD from progressing.
For further reading, head over to the general health section of our website. Here, you’ll find information on everything from bone and heart health to ways to become more active. You might also find it useful to read our article; 13 foods that are good for your liver.
Have you got any more tips you’d like to share on living with non-alcoholic fatty liver disease? We’d be interested to hear from you in the comments below.
