We all love the scrumptious fries and an extra dash of cheese on our pizza and burger so much
that we completely forget their negative impact on our health. Oily and greasy foods cause fat
accumulation in our body and put us at greater risk of heart diseases, Diabetes, and pulmonary
embolism. Out of these commonly known harmful conditions one such serious health concern is
non-alcoholic fatty liver disease (NAFLD). NAFLD IS characterized by excessive fat deposition in
he hepatic (liver) cells. It is more prevalent (30%) in developed than the developing nations.
Non-alcoholic fatty liver disease is accumulation of fat in the liver. This condition ranges from
simple steatosis (fat accumulation in the liver) to more advanced steatosis progressing to related
conditions like fibrosis, Hepatitis, cirrhosis and hepatocellular carcinoma (HCC). NAFLD is bifurcated
into the nonalcoholic fatty liver (NAFL) and nonalcoholic steatohepatitis (NASH). Non alcoholic fatty liver is steatosis
of fatty liver without hepatocyte (liver cells) injury, while nonalcoholic steatohepatitis involves liver cells injury due to
excessive fat accumulation. Non alcoholic steatohepatitis causes liver scarring (fibrosis) in some patients.
Risk Factors of Non-alcoholic fatty liver disease
- Obesity
Excessive intra-abdominal fat and its distribution in obese individuals is the key determinant
in the development of Non-alcoholic fatty liver disease due to its strong association with insulin resistance.
- Diet, smoking and lifestyle
A diet high in fat can trigger the development of Non-alcoholic fatty liver disease. Cigarette contains tobacco that
predisposes a person to the development of insulin resistance. Sedentary lifestyle (reduced
physical activity) increases the risk of NAFLD.
- Age and gender
Prevalence of Non-alcoholic fatty liver disease increases with age and is more common in men. However, the severity
of Non alcoholic steatohepatitis is more in women than men.
- Metabolic Syndrome and type 2 diabetes
Incidences of Non-alcoholic fatty liver disease are rising with increasing prevalence of metabolic syndromes. The
underlying cause is the insulin resistance. Type 2 diabetics have around 80% higher
chances of developing Non alcoholic steatohepatitis.
- Polycystic ovarian syndrome (PCOS)
PCOS is a hormonal disorder which is prevalent among women of reproductive age. Women
with PCOS are reported to be hyper-androgenemic (having excessive levels of androgenmale
sex hormone). This condition is related to insulin resistance, and therefore increasing
their chances of having Non-alcoholic fatty liver disease.
- Genetics
Genetics plays an important role in the development and progression of NAFLD along with
environmental factors. Polymorphisms in gene PNPLA3 are responsible for steatosis and
progressive hepatic injury.
Symptoms of Non-alcoholic fatty liver disease
Symptoms is generally asymptomatic, but some might experience symptoms like pain in the upper
right side of the abdomen. Physical examination demonstrates an enlarged liver. In the
advanced stage (cirrhosis), following
are the most common signs and symptoms - Fatigue, jaundice, abdominal pain,
hepatomegaly (enlarged liver), ascites (accumulation of fluid in abdominal cavity causing
abdominal swelling), water retention, gastro intestinal bleeding and liver encephalopathy.
Read:
Guide to Liver Cirrhosis: Causes, Symptoms, Types, Stages, Treatment
Diagnosis of Non-alcoholic fatty liver disease
Liver Enzyme Test
- Alanine transaminase (ALT) and Aspartate transaminase (AST)
Are simple blood tests that help to diagnose and identify abnormalities and diseases associated
with the liver. Elevated levels of ALT and AST indicate liver dysfunction or damage. AST/ALT ratio
aids in differentiation of Non alcoholic steatohepatitis and alcoholic liver disorder. A mean AST/ALT ratio of 1.4 is observed
in patients with cirrhosis related to Non alcoholic steatohepatitis.
- Alkaline phosphatase (ALP) and Gamma-glutamyl transferase (GGT)
These are liver enzymes that are estimated to identify any abnormalities, damages or
diseases related to the liver.
- Total bilirubin Test
Helps in assessment of liver disease associated with cirrhosis.
- Albumin (A)
Elevated albumin levels indicate liver issues related to cirrhosis. Low levels are indicative
of liver cirrhosis or related problems.
- Albumin/Globulin (A/G) ratio
Low A/G ratio may suggest autoimmune diseases or liver cirrhosis and higher ratios may
reflect some genetic deficiencies.
Lipid Profile
Triglycerides (TG), low density lipoprotein (LDL) and cholesterol tests can indicate if there
is significant increase in lipid values which helps in diagnosis of Non-alcoholic fatty liver disease.
Tests for Diabetes
- Fasting Blood Sugar and HbA1c Test
The HbA1c Test helps to check the levels of intracellular glucose and to diagnose diabetes. Moreover,
it may also suggest Non-alcoholic fatty liver disease, as type 2 diabetics have increased risk of Non-alcoholic fatty liver disease.
- Insulin Test
It helps in diagnosis of Non-alcoholic fatty liver disease, as insulin resistance is the common factor between
Non-alcoholic fatty liver disease and metabolic syndrome.
Hepatitis Test
- HbsAg and HCV Ab Test
The hepatitis B virus antigen test (HbsAg) diagnoses hepatitis B virus (HBV) infection,
while hepatitis C virus infection is detected accurately with HCV Ab test. HBV and HCV
infection are both associated with higher risk of non-alcoholic fatty liver disease (NAFLD).
Radiological Evaluation - Ultrasonography
It involves high frequency sound waves to produce images of internal structures of the body.
It is used to diagnose Non-alcoholic fatty liver disease, however it cannot accurately.
Computerized Tomography (CT imaging)
It is a noninvasive procedure that uses X-ray to provide cross-sectional images of the liver.
It accurately quantifies and determines the amount of steatosis.
Magnetic Resonance Imaging (MRI)
This is a noninvasive technique that gives the detailed image of the liver by using the magnetic
field and radio waves. It helps in accurate detection, diagnosis and quantification of hepatic steatosis.
Liver Biopsy
Liver biopsy is a procedure that involves insertion of a fine needle into the liver for the
collection of the tissue sample. This tissue sample is analyzed through histopathology
examination. It is useful in the diagnosis of Non alcoholic steatohepatitis as it precisely elucidates the difference
between hepatic steatosis from steatohepatitis.
Management of Non-alcoholic fatty liver disease
BMI measurement of body fat against the height and weight of an individual helps
to prospectively identify the risks of Non-alcoholic fatty liver disease and to plan weight management.
Lifestyle changes, physical activity and healthy diet are the basis of management program
to deal with Non alcoholic steatohepatitis and steatosis.
