The definition of NAFLD requires that (a) there be the presence of fat within the liver cells (hepatic steatosis) either by radiological imaging or on histological examination of the liver through a liver biopsy and (b) no other identifiable causes of fat accumulation in the liver such as excessive alcohol comsumption, hepatitis C, medications or heriditary liver diorders.
NAFLD most commonly affects the middle-aged and elderly as risk factors such as obesity, hypertension, type II diabtests and hyperlipidaemia increase with age, however there is increasing prevalence of NAFLD being diagnosed in children and young adults who are overweight or obese. As obesity rates have risen in Singapore, the prevalence of NAFLD has also increased.
Although almost 40-50% of the population have NAFLD, only a small proportion of people will develop complications due to NAFLD.
NAFLD – Who Is At Risk Of Liver Disease Progression?
Patients with NAFLD can be divided into 2 groups. Those with either:
- Simple Steatosis or Fatty Liver –There is fat deposition in the liver but with little or no inflammation and liver cell damage. It generally does not cause progressive liver disease or complications such as liver cirrhosis, liver failure of liver cancer. Patients with simple fatty liver make up the majority of patients.
- Nonalcoholic steatohepatitis (NASH) – Occurs when fat deposition in the liver results in inflammation in the liver. If this inflammation in the liver continues over many decades, this may lead to scarring or fibrosis in the liver and eventually liver cirrhosis, liver failure and increases the risk of liver cancer. Steatohepatitis can be diagnosed through liver blood tests and a liver biopsy.
Symptoms of NAFLD
NAFLD is often a quietly progressive disease. Patients with NAFLD are often diagnosed incidentally when they visit a doctor and go for health screening. Often NAFLD is detected on ultrasound scan of the liver or NAFLD is suspected because of abnormal liver blood tests. NAFLD can have few or no symptoms in the early stages of disease. However, patients with advanced liver disease or cirrhosis or liver cancer may have symptoms including fatigue, jaundice, confusion, gastrointestinal bleeding, loss of weight, loss of appetite, abdominal bloating and distension and pain in the upper abdominal area.
Assessment of NAFLD
Patients with NAFLD and especially those with steatohepatitis or NASH should undergo further assessment by their doctor to exclude other causes of liver disease and have a baseline assessment of whether they already have progressive liver disease either by Fibroscan liver stiffness measurement or liver biopsy. They should also be screened for associated risk factors such as Type II diabetes, hypertension and hyperlipidaemia.
Management Of NAFLD
Currently the cornerstone of management for NAFLD is lifestyle modification and weight loss along with the treatment of associated metabolic risk factors such as Type II diabetes, hypertension and hyperlipidaemia.
- In overweight/obese patients with NAFLD, a 7–10% weight loss is the target of most lifestyle interventions. Weight loss has been associated with a reduction in the fat within the liver and also an improvement in liver blood tests and liver histology.
- Dietary recommendations should include total calorie reduction of 500-1000 Kcal/day and the exclusion of NAFLD-promoting components (processed food, and food and beverages high in added fructose).
- Abstinence from alcohol
- Regular exercise two to three times a week for 30 to 60 minutes to lose weight and reduce fat in the liver. Both aerobic exercise and resistance training have been shown to effectively reduce liver fat.
Patients with advanced liver disease such as liver cirrhosis should be followed up by a specialist to monitor for complications and for liver cancer screening and surveillance. Patients with NAFLD and advanced liver cirrhosis or liver cancer may also be treated by liver transplantation.
Head down to gutCARE in Singapore and talk to one of our specialists today regarding any health concerns. Our gastroenterology clinicprovides sub-specialized care services for digestive and liver disorders. The cost of most investigations should be covered by majority of medical insurance providers. gutCARE also performs Fibroscan liver stiffness assessment, a state-of-the-art non-invasive tool used to provide a complete assessment of your liver health and check for progressive liver disease. Contact us to arrange for an appointment or speak to our friendly staff regarding any queries including cost of services.
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