Nonalcoholic fatty liver disease is a term used to describe the accumulation of fat in the liver of people who drink little or no alcohol.
Nonalcoholic fatty liver disease is common and, for most people, causes no signs and symptoms and no complications.
But in some people with nonalcoholic fatty liver disease, the fat that accumulates can cause inflammation and scarring in the liver. This more serious form of nonalcoholic fatty liver disease is sometimes called nonalcoholic steatohepatitis.
At its most severe, nonalcoholic fatty liver disease can progress to liver failure.
Nonalcoholic fatty liver disease usually causes no signs and symptoms. When it does, they may include:
- Pain in the upper right abdomen
- Weight loss
When to see a doctor
Make an appointment with your doctor if you have persistent signs and symptoms that cause you concern.
Nonalcoholic fatty liver disease occurs when your liver has trouble breaking down fats, causing fat to build up in your liver tissue.
Doctors aren't sure what causes nonalcoholic fatty liver disease. The wide range of diseases and conditions linked to nonalcoholic fatty liver disease is so diverse that it's difficult to pinpoint any one cause.
Types of nonalcoholic fatty liver disease
Nonalcoholic fatty liver disease can take several forms — from harmless to life-threatening. Forms include:
- Nonalcoholic fatty liver. It's not normal for fat to build up in your liver, but it won't necessarily hurt you. In its simplest form, nonalcoholic fatty liver disease can cause excess liver fat, but no complications. This condition is thought to be very common.
- Nonalcoholic steatohepatitis. In a small number of people with fatty liver, the fat causes inflammation in the liver. This can impair the liver's ability to function and lead to scarring of the liver (cirrhosis).
- Nonalcoholic fatty liver disease-associated cirrhosis. Liver inflammation leads to scarring of the liver tissue. With time, scarring can become so severe that the liver no longer functions adequately (liver failure).
A wide range of diseases and conditions can increase your risk of nonalcoholic fatty liver disease, including:
- Gastric bypass surgery
- High cholesterol
- High levels of triglycerides in the blood
- Metabolic syndrome
- Polycystic ovary syndrome
- Sleep apnea
- Type 2 diabetes
- Underactive thyroid (hypothyroidism)
- Underactive pituitary gland (hypopituitarism)
Start by making an appointment with your family doctor or a general practitioner if you have signs and symptoms that worry you. If your doctor suspects you may have a liver problem, such as nonalcoholic fatty liver disease, you may be referred to a doctor who specializes in the liver (hepatologist).
Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be well-prepared. Here's some information to help you get ready, and what to expect from your doctor.
What you can do
- Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet.
- Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
- Write down key personal information, including any major stresses or recent life changes.
- Make a list of all medications, as well as any vitamins or supplements, that you're taking.
- Take any relevant medical records, such as records of any tests you've had that relate to your current condition.
- Take a family member or friend along. Sometimes it can be difficult to absorb all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.
- Write down questions to ask your doctor.
Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important, in case time runs out. For nonalcoholic fatty liver disease, some basic questions to ask include:
- What is causing fat to build up in my liver?
- Is the fat in my liver hurting my health?
- Will my fatty liver disease progress to a more serious form?
- What are my treatment options?
- Will losing weight or changing my diet reduce the amount of fat in my liver?
- What can I do to keep my liver healthy?
- I have these other health conditions. How can I best manage them together?
- Should I see a specialist? What will that cost, and will my insurance cover it?
- Are there any brochures or other printed material that I can take with me? What websites do you recommend?
- What will determine whether I should plan for a follow-up visit?
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment.
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may allow more time later to cover other points you want to address. Your doctor may ask:
- Have you experienced any symptoms, such as yellowing of the eyes or skin, abdominal pain or swelling, or swelling in your legs? What were the results of tests done at that time?
- Do you drink alcohol?
- What medications do you take, including over-the-counter drugs and supplements?
- Have you ever been told that you have hepatitis?
- Do other people in your family have liver disease?
Tests and procedures used to diagnose nonalcoholic fatty liver disease include:
- Blood tests. Liver function tests, including tests of liver enzymes, may help your doctor make a diagnosis.
- Imaging procedures. Imaging procedures used to diagnose fatty liver disease include ultrasound, computerized tomography (CT) scan and magnetic resonance imaging (MRI).
Liver tissue testing. If it's suspected that you have a more serious form of nonalcoholic fatty liver disease, your doctor may recommend a procedure to remove a sample of tissue from your liver (liver biopsy). The tissue sample is examined in a laboratory to look for signs of inflammation and scarring.
Liver biopsy is typically done using a long needle inserted through your skin and into your liver to remove liver cells (needle biopsy).
No standard treatment for nonalcoholic fatty liver disease exists.
Instead, doctors typically work to treat the risk factors that contribute to your liver disease. For instance, if you're obese, your doctor can help you to lose weight through diet, exercise and, in some cases, medications and surgery.
Your doctor may recommend that you receive vaccinations against hepatitis A and hepatitis B to help protect you from viruses that may cause further liver damage.
Along with your doctor's help, you can take steps to control your nonalcoholic fatty liver disease. You can:
- Lose weight. If you're overweight or obese, reduce the number of calories you eat each day and increase your physical activity in order to lose weight. If you've tried to lose weight in the past and have been unsuccessful, ask your doctor for help.
- Choose a healthy diet. Eat a healthy diet that's rich in fruits, vegetables and whole grains.
- Exercise and be more active. Aim for at least 30 minutes of exercise most days of the week. If you're trying to lose weight, you might find that more exercise is helpful. But if you don't already exercise regularly, get your doctor's OK first and start slowly.
- Control your diabetes. Follow your doctor's instructions to stay in control of your diabetes. Take your medications as directed and closely monitor your blood sugar.
- Lower your cholesterol. A healthy plant-based diet, exercise and medications can help keep your cholesterol and your triglycerides at healthy levels.
- Protect your liver. Avoid things that will put extra stress on your liver. For instance, don't drink alcohol. Follow the instructions on all medications and over-the-counter drugs.
No alternative medicine treatments are proven to cure nonalcoholic fatty liver disease. But researchers are studying whether some natural compounds could be helpful, such as:
Vitamin E. In theory, vitamin E and other vitamins called antioxidants could help protect the liver by reducing or neutralizing the damage caused by inflammation. But more research is needed.
Some evidence suggests vitamin E supplements may be helpful for people with liver damage caused by nonalcoholic fatty liver disease. But vitamin E has side effects, such as an increased risk of death and, in men, an increased risk of prostate cancer.
Discuss the benefits and risks of vitamin E with your doctor.
Coffee. In one study, people with nonalcoholic fatty liver disease who reported drinking coffee had less liver damage than those who drank little or no coffee. It's not clear how coffee may influence liver damage or how much coffee you'd need to drink in order to benefit.
If you already drink coffee, these results may make you feel better about your morning cup of coffee. But if you don't already drink coffee, this probably isn't a good reason to start. Discuss the potential benefits of coffee with your doctor.
To reduce your risk of nonalcoholic fatty liver disease:
- Choose a healthy diet. Choose a healthy plant-based diet that's rich in fruits, vegetables, whole grains and healthy fats.
- Maintain a healthy weight. If you are overweight or obese, reduce the number of calories you eat each day and get more exercise. If you have a healthy weight, work to maintain it by choosing a healthy diet and exercising.
- Exercise. Exercise most days of the week. Get an OK from your doctor first if you haven't been exercising regularly.
- Teamwork. At Mayo Clinic, digestive disease specialists (gastroenterologists) work closely with liver experts (hepatologists), radiologists and pathologists to care for people with nonalcoholic fatty liver disease. Other professionals are included as needed.
- Expertise. Mayo Clinic doctors described and named this disease in 1980.
- Experience. Mayo Clinic doctors have cared for many people with nonalcoholic fatty liver disease, including those with minimal liver damage and those with very serious liver failure. Mayo Clinic doctors care for about 6,000 people with nonalcoholic fatty liver disease each year.
- A full range of treatment options to consider. Mayo Clinic doctors will work with you to review all of your treatment options and choose the treatment that best suits your needs and goals. A range of treatment options are available to you, depending on your specific situation. Treatments may include help making lifestyle changes, medications and surgical procedures, such as weight-loss surgery and liver transplant.
- Innovation. Mayo Clinic doctors and researchers have developed a noninvasive way to test for liver scarring. They hope this new technology, called magnetic resonance elastography, may one day reduce the need for liver biopsies in people with liver disease.
Mayo Clinic in Rochester, Minn., ranks No. 1 for digestive disorders in the U.S. News & World Report Best Hospitals rankings. Mayo Clinic in Scottsdale, Ariz., and Mayo Clinic in Jacksonville, Fla., are ranked among the Best Hospitals for digestive disorders by U.S. News & World Report.
Mayo Clinic works with hundreds of insurance companies and is an in-network provider for millions of people. In most cases, Mayo Clinic doesn't require a physician referral. Some insurers require referrals or may have additional requirements for certain medical care. All appointments are prioritized on the basis of medical need.
Specialists in gastroenterology and hepatology at Mayo Clinic in Arizona care for adults who have nonalcoholic fatty liver disease. They often work closely with other specialists, such as radiologists and pathologists. Other experts are included, as needed.
For appointments or more information, call the Central Appointment Office at 800-446-2279 (toll-free) 8 a.m. to 5 p.m. Mountain Standard Time, Monday through Friday or complete an online appointment request form.
- U.S. Patients
- International Patients
Specialists in gastroenterology and hepatology at Mayo Clinic in Florida care for adults who have nonalcoholic fatty liver disease. They often work closely with other specialists, such as radiologists and pathologists. Other experts are included, as needed.
For appointments or more information, call the Central Appointment Office at 904-953-0853 8 a.m. to 5 p.m. Eastern time, Monday through Friday or complete an online appointment request form.
- U.S. Patients
- International Patients
Specialists in gastroenterology and hepatology at Mayo Clinic in Minnesota care for children and adults who have nonalcoholic fatty liver disease. They often work with other specialists, such as radiologists and pathologists. Other experts are included, as needed.
Doctors in pediatric gastroenterology and hepatology care for children with nonalcoholic fatty liver disease.
For appointments or more information, call the Central Appointment Office at 507-538-3270 7 a.m. to 6 p.m. Central time, Monday through Friday or complete an online appointment request form.
- U.S. Patients
- International Patients
See information on patient services at the three Mayo Clinic locations, including transportation options and lodging.
Mayo Clinic doctors and scientists are studying new ways of diagnosing and treating nonalcoholic fatty liver disease. Research areas include studying the causes of nonalcoholic fatty liver disease and improving diagnosis of the disease through the use of noninvasive testing with magnetic resonance elastography, among others.
See a list of publications by Mayo Clinic authors on nonalcoholic fatty liver disease on PubMed, a service of the National Library of Medicine.
- Michael R. Charlton, M.D.
- Vandana Nehra, M.D.
April 10, 2014
- Non-alcoholic fatty liver disease (NAFLD). American College of Gastroenterology. http://patients.gi.org/topics/fatty-liver-disease-nafld. Accessed Sept. 26, 2013.
- Non-alcoholic fatty liver disease. American Liver Foundation. http://www.liverfoundation.org/abouttheliver/info/nafld. Accessed Sept. 26, 2013.
- Feldman M, et al. Sleisenger & Fordtran's Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. 9th ed. Philadelphia, Pa.: Saunders Elsevier; 2010. http://www.clinicalkey.com. Accessed Sept. 26, 2013.
- Chalasani N, et al. The diagnosis and management of non-alcoholic fatty liver disease: Practice guideline by the American Gastroenterological Association, American Association for the Study of Liver Diseases and American College of Gastroenterology. Gastroenterology. 2012;142:1592.
- Molloy JW, et al. Association of coffee and caffeine consumption with fatty liver disease, nonalcoholic steatohepatitis and degree of hepatic fibrosis. Hepatology. 2012;55:429.
- Golden AK. Decision Support System. Mayo Clinic, Rochester, Minn. Aug. 16, 2013.
- Ludwig J, et al. Nonalcoholic steatohepatitis: Mayo Clinic experiences with a hitherto unnamed disease. Mayo Clinic Proceedings. 1980;55:434
- Venkatesh SK, et al. Magnetic resonance elastography of liver: Technique, analysis and clinical applications. Journal of Magnetic Resonance Imaging. 2013;37:544.
- ACIP Adult Immunization Work Group. Advisory Committee on Immunization Practices (ACIP) recommended immunization schedule for adults aged 19 years and older — United States, 2013. MMWR. 2013;62:13. http://www.cdc.gov/mmwr/preview/mmwrhtml/su6201a3.htm?s_cid=su6201a3_w. Accessed Oct. 11, 2013.