Nonalcoholic Fatty Liver Disease (NFLD)

Diagnosis

NAFLD often remains asymptomatic, and its detection commonly occurs incidentally during tests conducted for unrelated reasons that indicate a potential liver issue. For instance, elevated liver enzyme levels revealed in a routine blood test during an annual examination may prompt further investigations, ultimately leading to the diagnosis of NAFLD.

Tests conducted for diagnosing NAFLD, excluding other diseases, and assessing the extent of liver damage include:

• Blood tests:
  • Complete blood count, providing insights into the composition of your blood.
  • Iron studies to determine the levels of iron in both your blood and cells.
  • Liver enzyme and liver function tests for assessing liver health.
  • Screening tests for chronic viral hepatitis, including hepatitis A, hepatitis C, and others.
  • Celiac disease screening to identify potential gluten-related issues.
  • Fasting blood sugar test to evaluate glucose levels after a period of fasting.
  • Hemoglobin A1C test, indicating the stability of your blood sugar over time.
  • Lipid profile, measuring blood fats such as cholesterol and triglycerides.
• Imaging procedures
  • Abdominal ultrasound, which is frequently the initial test when liver disease is suspected.
  • Magnetic resonance imaging (MRI) or computerized tomography (CT) scanning, which are more effective in detecting mild liver fibrosis but cannot differentiate between non-alcoholic steatohepatitis (NASH) and NAFLD.
  • Transient elastography, a modern ultrasound variant that measures liver stiffness as an indicator of fibrosis or scarring.
  • Magnetic resonance elastography, a combination of MRI and sound waves that produces a visual map, known as an elastogram, illustrating tissue stiffness.
• Liver biopsy: If additional tests indicate advanced liver disease or non-alcoholic steatohepatitis (NASH), or if your test results are inconclusive, your doctor may recommend a liver biopsy. This procedure involves obtaining a small tissue sample from the liver using a needle inserted through the abdominal wall. The extracted tissue is then examined in a laboratory for signs of inflammation and scarring, providing the most accurate diagnosis of NASH and a clear assessment of the extent of liver damage. While a liver biopsy can be uncomfortable and carries associated risks, your healthcare team will thoroughly discuss these considerations with you before proceeding.

Treatment

The initial approach to treating non-alcoholic fatty liver disease (NAFLD) often involves weight loss, achieved through a combination of adopting a healthy diet, managing portion sizes, and engaging in regular exercise. Improving overall health through weight loss can address underlying issues contributing to NAFLD, with a recommended target of losing at least 10% of body weight. Benefits can still be realized with a weight loss as modest as 3% to 5% of the initial weight. In specific cases, weight-loss surgery or medications may be considered. However, for individuals with cirrhosis resulting from non-alcoholic steatohepatitis (NASH), a liver transplant may be necessary.