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Non-Alcoholic Fatty Liver Disease (NAFLD)

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NAFLD or Non alcoholic fatty liver disease is now one of the leading causes of liver failure. This disease is not related to alcohol use but involves hepatic fatty infiltration.

It is a spectrum of macrovesicular hepatic steatosis that eventually leads to inflammation and eventual fibrosis.

Lab results consistent with this disorder include elevated liver enzymes or transaminases also known as ALT and AST. 

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CAUSES

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Fatty liver is caused mainly due to insulin resistance. Insulin is needed to regulate the metabolism of carbohydrates, fats, and proteins by enhancing the absorption of glucose and conversion to fats in the liver. Insulin resistance happens when the insulin receptor malfunctions until insulin and glucose start to increase. The increase in insulin leads to activated or increased lipogenesis (fat synthesis) in the liver and the fat-making process resultantly becomes abnormal causing fatty deposits in the liver; that is, the disease.

 

RISK FACTORS

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  • Obesity

  • Metabolic Syndrome

  • Type 2 Diabetes

  • Hypertension

  • Dyslipidemia

  • Note: Although non-alcoholic fatty liver disease by definition is not caused by alcohol, excessive alcohol use can worsen liver damage and lead to liver failure sooner rather than later. 

 

 

SIGNS AND SYMPTOMS

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The condition is mostly asymptomatic and makes it quite difficult to diagnose. Vague symptoms like malaise, fatigue, and RUQ (Right Upper Quadrant) discomfort (gnawing or aching sensation) might be useful precursors to investigating the possibility of the condition. 

Most cases of fatty liver or NAFLD are diagnosed as incidentally based upon routine blood test results. 

 

 

LABORATORY INVESTIGATIONS

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Additional lab testing to be done if NAFLD is found includes;

  • Lipid / Cholesterol panel

  • Metabolic panel including testing for diabetes

  • Additional tests of liver function

  • Markers for viral hepatitis 

  • Tests for liver diseases such as autoimmune hepatitis, storage diseases

 

Imaging

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  • Liver Ultrasound 

 

PREVENTION & TREATMENT

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  1. Weight loss (0.5-1kg/week): The goal is to lose at least 10% of body weight as rapid weight loss can worsen NAFLD. Weight loss can be achieved with diet, exercise, medications and bariatric or weight loss surgery.

  2. Refraining from ethanol use is the key to slowing progression

  3. Liver transplantation 

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Other treatments with possible benefits

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  • Vitamin D

  • Vitamin E (800 Units) if hepatic inflammation

  • Coffee drinking (3 cups per day)

  • Omega 3 fatty acids

  • Glucose lowering medications 

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