Non-Alcoholic Fatty Liver Disease

Overview

Non-alcoholic fatty liver disease (NAFLD) is a condition where fat builds up in your liver. It is not caused by drinking alcohol. For many people, it causes no problems, but for some it can lead to liver damage over time.

Yes, it is very common. NAFLD is the most common liver problem in many countries, including the UK.

NAFLD can affect anyone, but it is more common in people who are overweight or obese, have type 2 diabetes, have high blood pressure or high cholesterol, or have a family history of liver disease.

Symptoms

Common symptoms

• Often no symptoms at all in the early stages.
• A dull ache or feeling of fullness in the upper right side of the belly.
• Unexplained tiredness or fatigue.

Symptoms in children

• Like adults, children often have no symptoms.
• They may complain of belly pain or feel very tired.
• Sometimes parents notice a child’s belly looking swollen or feeling hard.

Symptoms in older adults

• Symptoms may be milder and easier to overlook, such as general weakness or loss of appetite.
• Older adults may confuse symptoms with normal aging or other conditions.

Causes

Main causes

• The exact cause is not fully understood, but it involves a buildup of fat in liver cells not caused by alcohol.
• This fat buildup may be linked to how your body processes sugar and fats.

Risk factors

• Being overweight or obese, especially around your belly.
• Having type 2 diabetes or prediabetes.
• Having high cholesterol or high triglycerides (a type of fat in your blood).
• Having high blood pressure.
• Eating a diet high in sugary foods and drinks.
• Rapid weight loss or a very unhealthy diet.
• Some medicines, such as certain steroids or chemotherapy drugs (talk to your doctor if you have concerns).

When to see a doctor

See a doctor urgently if:

• If you have any of the emergency symptoms listed above, call your local emergency number immediately.
• If you have symptoms like persistent tiredness, belly swelling, or jaundice, see a doctor as soon as possible.

Book a routine appointment if:

• If you have risk factors like diabetes, obesity, or high cholesterol, talk to your doctor at your next check-up whether you need a liver check.
• If you have a family history of liver disease or cirrhosis.

Diagnosis

NAFLD is often found by chance during blood tests or scans for other reasons. Your doctor will ask about your health, lifestyle, and any symptoms, and then do tests to confirm the diagnosis.

Tests that may be done

• Blood tests to check your liver enzymes and rule out other causes of liver problems.
• An ultrasound scan to look for fat in your liver.
• A special scan called FibroScan or transient elastography to measure liver stiffness (scarring).
• Sometimes a liver biopsy (taking a small piece of liver with a needle) to see how much fat and scarring is present.

What to expect at your appointment

Diagnosis is usually straightforward. Most tests are painless or involve minimal discomfort. Your doctor will explain each test and what the results mean.

Treatment

There is no medicine specifically approved to cure NAFLD. The main treatment is healthy lifestyle changes, which can often reverse the early stages and prevent progression.

Self-care at home

• Lose weight if you are overweight – losing 5-10% of your body weight can significantly reduce liver fat.
• Eat a balanced diet low in saturated fats, added sugars, and refined carbohydrates.
• Exercise regularly – at least 150 minutes of moderate activity per week, such as brisk walking.
• Avoid alcohol completely, as it can make liver damage worse.
• Manage other health problems like diabetes, high blood pressure, and high cholesterol.

Medical treatments

Your doctor may prescribe medicines to treat conditions that contribute to NAFLD, such as diabetes, high cholesterol, or high blood pressure. These medicines can help control your health and may slow liver damage, but they are not a cure for the fatty liver itself. Always take medicines only as prescribed by your doctor.

When is surgery considered?

If NAFLD progresses to end-stage cirrhosis (severe scarring) and liver failure, a liver transplant may be considered. This is a major surgery and is only for advanced cases. Your healthcare team will discuss all options with you if needed.

Living with this condition

Living with NAFLD usually means adopting a liver-friendly lifestyle. Most people can manage it well with diet, exercise, and regular check-ups. It is important to keep a healthy weight and follow your doctor’s advice.

Lifestyle tips

• Eat plenty of vegetables, fruits, whole grains, and lean proteins like fish and chicken.
• Limit red meat, full-fat dairy, fried foods, and sugary snacks or drinks.
• Stay active every day – even a 30-minute walk can help.
• Get enough sleep and manage stress.

Diet and exercise

A combination of a healthy diet and regular exercise is the most effective way to reduce liver fat. Aim for a diet rich in fibre and low in unhealthy fats and sugars. Try to do both aerobic exercise (walking, cycling) and strength exercises (light weights or bodyweight exercises) a few times a week.

Mental health and emotional wellbeing

Living with a chronic condition can feel worrying or stressful. It is normal to feel anxious about your health. If you feel down or overwhelmed, talk to your doctor or a counsellor. You are not alone.

Prevention

In many cases, yes. A healthy lifestyle with a balanced diet, regular exercise, and maintaining a healthy weight greatly reduces your risk. Avoid sugary drinks and foods high in unhealthy fats.

Vaccines

If you have liver disease, your doctor may recommend the hepatitis A and hepatitis B vaccines to protect your liver from these viruses.

Screening programmes

There is no routine screening for the general population, but if you have risk factors (such as diabetes or obesity) your doctor may suggest blood tests or a liver ultrasound as part of your regular care.

Complications

If left untreated

• Fatty liver may progress to non-alcoholic steatohepatitis (NASH), where there is inflammation and liver cell damage.
• Over time, inflammation can cause scarring (fibrosis) and eventually cirrhosis (severe scarring).
• Cirrhosis can lead to liver failure or liver cancer.

Long-term outlook

The outlook for most people with NAFLD is very good. Many people have only a fatty liver without damage, and it can be reversed with lifestyle changes. Even if you have mild inflammation, treatment can prevent it from getting worse. For those who develop cirrhosis, there are treatments to manage the condition and improve quality of life. Early detection and healthy habits make a big difference.

Find support

International organisations

• British Liver Trust ↗
• American Liver Foundation ↗

Local organisations

• NHS – Non-alcoholic fatty liver disease ↗ · United Kingdom

Helplines

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