Understanding NAFLD: Non-Alcoholic Fatty Liver Disease, Symptoms, Causes, and Management

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Non-Alcoholic Fatty Liver Disease (NAFLD) is a widespread liver condition that affects millions of people worldwide. It is considered a range of conditions that is caused when fat builds up in the liver impairing the function of the liver.

NAFLD is a leading cause of liver failure worldwide affecting 47 in every 1000 people. In India, it is estimated that 16-32% or nearly 120 million people have NAFLD, among which nearly 31% are diagnosed with NASH, (Non-alcoholic steatohepatitis) or stage 2 of NAFLD. The most common causes of NAFLD in India are industrialization and change in lifestyle and diet with less physical activity and increased calorie rich foods. NAFLD usually occurs in overweight and obese people, but others can get it too because of wrong dietary choices and unhealthy nutrition. NAFLD is not associated with excessive alcohol consumption but is rather linked to metabolic factors.

The Four Stages of NAFLD

NAFLD often develops silently without presenting any noticeable symptoms in its early stages. There are 4 stages of NAFLD with people developing the first stage without even knowing it. Some cases might eventually progress to liver damage when not detected.

The four stages of NAFLD are:

  • Simple fatty liver (Steatosis): Fat build up in liver cells which can be only diagnosed during tests carried out for other issues. The condition is not considered serious.
  • Non-alcoholic steatohepatitis (NASH): An inflammed liver considered more serious than steatosis.
  • Fibrosis: Constant liver inflammation causes scarring in the tissue around the liver and nearby blood vessels. The liver still functions normally
  • Cirrhosis: The most severe form of liver disease after years of inflammation. The liver shrinks and becomes scarred and lumpy. Liver cirrhosis is permanent damage and can lead to liver failure or liver cancer

NAFLD in its early stages isn’t harmful, but if left untreated, it can progress to serious liver damage and possibly even cirrhosis of the liver. High levels of fat in the liver also increase the risk of other issues like diabetes, hypertension, and kidney disease. In people with diabetes, NAFLD increases the chance of developing heart problems. NAFLD needs to be diagnosed at an early stage where it can be easily treated with medication and healthy lifestyle modifications. This helps reduce the amount of fat in your liver.

Today, NAFLD is widely regarded as part of the conditions that make up metabolic syndrome which includes diabetes, pre diabetes or insulin resistance, elevated lipids, high cholesterol, triglycerides, and hypertension. It isn’t necessary to have all these conditions to qualify for a metabolic syndrome diagnosis, and NAFLD is one of them that eventually graduates to NASH. Till now, researchers are trying to figure out what exactly causes NASH. Fibrosis or cirrhosis takes years to develop which means your liver gives you ample chance to reduce the risk of the condition. Lifestyle and diet modifications are crucial to prevent this stage.

Symptoms of NAFLD

In the early stages, there are no symptoms of NAFLD, but as it progresses, one might begin to experience the following symptoms.

  • Fatigue: Persistent tiredness and lack of energy may be early signs of NAFLD.
  • Abdominal discomfort: Discomfort or pain in the upper right side of the abdomen (over the lower side of the ribs) may occur.
  • Unexplained weight loss or gain: Fluctuations in weight without a clear cause can be associated with NAFLD.
  • In Cirrhosis:
  • Jaundice: In severe cases, yellowing of the skin and eyes (jaundice) may occur due to liver damage.
  • Swelling: Accumulation of fluid in the abdomen (ascites) or swelling in the legs may be observed.
  • Itchy Skin

Causes of Non-Alcoholic Fatty Liver Disease

The main causes or triggers that put you at risk of NAFLD are:

  • Insulin resistance: NAFLD is often associated with insulin resistance, a condition where the body’s cells become less responsive to insulin.
  • Obesity: Excess body weight, especially around the abdominal area, is a significant risk factor for NAFLD.
  • Type 2 diabetes: People with diabetes are at an increased risk of developing NAFLD.
  • Elevated lipid profile: Elevated levels of triglycerides and other fats in the blood can contribute to the development of fatty liver.
  • Genetics: Genetic factors may play a role in the susceptibility to NAFLD.
  • Sedentary lifestyle: Lack of physical activity is linked to the development and progression of NAFLD.
  • An underactive thyroid: Research has found how hypothyroidism could be a cause for NAFLD

Other factors:

As surprising as it sounds, NAFLD has also been diagnosed in people with no risk factors including children. The condition is like liver disease caused by alcohol or ARLD, but in the case of NAFLD, alcohol is not the reason.


NAFLD is often diagnosed incidentally during routine medical examinations or when investigating other health concerns. Diagnostic tools include:

Blood tests: Elevated liver enzymes may indicate liver inflammation.

Imaging studies: Ultrasound, CT scans, and MRI can provide detailed images of the liver, helping to assess the extent of fat accumulation.

Liver biopsy: In some cases, a liver biopsy may be recommended to evaluate the severity of inflammation and fibrosis.

Treatment of Nonalcoholic Fatty Liver Disease

There is currently no specific medication approved for the treatment of NAFLD. However, lifestyle modifications play a crucial role in managing the condition. Medications are prescribed only to control some of the symptoms associated with NAFLD such as high blood pressure, diabetes, and high cholesterol. Treatment strategies include:

Weight loss: Gradual weight loss through a combination of a healthy diet and regular exercise is a cornerstone in managing NAFLD.

Physical activity: Regular exercise improves insulin sensitivity and helps in reducing liver fat.

Balanced diet: Adopting a balanced and nutritious diet is essential. Focus on whole grains, lean proteins, fruits, vegetables, and healthy fats while limiting processed foods, sugars, and saturated fats.

Control of underlying conditions: Managing conditions like diabetes and high blood pressure is crucial in controlling NAFLD progression.

Avoidance of alcohol: While NAFLD is not caused by alcohol, avoiding excessive alcohol consumption is recommended as it can worsen liver damage.

Foods to Avoid and Eat in NAFLD:

Diet plays a pivotal role in managing NAFLD. Here are some dietary recommendations:

Foods to avoid:

  • Sugary foods and beverages: High sugar intake can contribute to insulin resistance and fat accumulation in the liver.
  • Processed foods: Processed foods often contain unhealthy fats, additives, and preservatives that can contribute to liver inflammation.
  • Saturated and trans fats: Reducing the intake of saturated and trans fats is essential in managing NAFLD. Avoid fried foods and opt for healthier cooking methods.
  • Excessive salt: Limiting salt intake helps in managing fluid retention and reducing the risk of complications like ascites.
  • Red meat: High consumption of red meat is associated with an increased risk of NAFLD. Choose lean protein sources like poultry, fish, and plant-based proteins.

Foods to eat:

Fruits and vegetables: Rich in vitamins, minerals, and antioxidants, fruits and vegetables support overall health and liver function. Fruits and Vegetables good for liver are cabbage, cauliflower, broccoli, beetroot, berries, grapes, grapefruit, prickly pear. Turmeric is also good for the liver.

Whole grains: Opt for whole grains like brown rice, quinoa, and whole wheat, which provide fiber and essential nutrients.

Lean proteins: Include sources of lean protein such as fish, poultry, tofu, and legumes in your diet.

Healthy fats: Incorporate sources of healthy fats and omega three fatty acids such as avocados, nuts and seeds and olive oil, which are beneficial for liver health.

Green tea: Some studies suggest that green tea may have protective effects on the liver and could be included in a NAFLD-friendly diet.

Potential supplements that can help improve liver health (Consult your doctor first before taking any supplement)


NAFLD is a prevalent liver condition that demands attention due to its association with obesity, diabetes, and other metabolic factors. Early detection through routine medical check-ups, combined with lifestyle modifications, is crucial in managing the condition. Adopting a balanced diet, engaging in regular physical activity, and controlling underlying health conditions are key components of NAFLD management. The content here is for information only and individuals should consult with healthcare professionals for personalized advice and guidance on managing NAFLD effectively.