All About Non-Alcoholic Fatty Liver Disease – A Silent Epidemic

People who consume little to no alcohol can still develop a prevalent liver condition known as non-alcoholic fatty liver disease (NAFLD). NAFLD is most commonly found in individuals with obesity, characterized by an excessive accumulation of fat in the liver. It stands as the most widespread form of liver disease globally. The condition ranges in severity from mild hepatic steatosis (fatty liver) to a more severe disorder called non-alcoholic steatohepatitis (NASH). In contrast, the terminology for NAFLD and NASH has been updated to Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD), and Metabolic Dysfunction-Associated Steatohepatitis (MASH).

MASH involves fat deposition in the liver, leading to inflammation and damage. This damage can progress to cirrhosis and even liver cancer, mirroring the harm typically caused by heavy alcohol consumption.

MASLD is often asymptomatic, but when symptoms do occur, they may include fatigue, malaise, and discomfort or pain in the upper right abdomen. More severe symptoms related to MASH and cirrhosis can include itchy skin, abdominal swelling (ascites), shortness of breath, leg swelling, spider-like blood vessels under the skin, an enlarged spleen, red palms, and yellowing of the skin and eyes (jaundice).

The exact cause of why some fatty livers advance to MASH is poorly understood. However, several factors are associated with both MASLD and MASH, including genetics, being overweight or obese, insulin resistance (where cells do not properly respond to insulin), type 2 diabetes (hyperglycemia), and elevated levels of fats, especially triglycerides, in the blood. These combined factors contribute to the development of a fatty liver. Interestingly, some individuals may develop MASLD even in the absence of these risk factors.

Preventing MASLD and MASH includes:

Healthy Diet: Eat a balanced diet, and limit portion sizes.
Maintain Healthy Weight: Keep a healthy weight through diet and exercise. If overweight or obese, gradual weight loss is recommended.
Dietary Changes: Limit high-calorie fats to prevent obesity, and replace saturated and trans fats with unsaturated fats, especially omega-3 fatty acids. Eat more low-glycemic index foods (fruits, vegetables, whole grains). Avoid high-glycemic index foods (white bread, white rice, potatoes).
Limit Sugars: Avoid foods and drinks high in simple sugars, especially fructose in soft drinks, sports drinks, sweetened tea, and juices.
Minimize Alcohol: Reduce alcohol consumption to prevent further liver damage.

(Dr. Lorance Peter, Director – Gastroenterology & Hepatology, Sakra World Hospital, Bengaluru)