Harvard Women's Health Watch

What to do about nonalcoholic fatty liver disease

It once seemed that only people who drank excessively were at risk for fatty liver disease. Not anymore.

Nonalcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver disease in the United States. Almost unheard of before 1980, NAFLD is now believed to affect as many as 30% of adult Americans and is expected to become the main reason for liver transplant by 2022. NAFLD is not a single disease but rather a spectrum of disorders, all marked by the accumulation of fat inside liver cells. Under the microscope, this fatty buildup looks just like alcohol-induced fatty liver disease, but it occurs in people who consume little or no alcohol (less than two drinks a day for women). The condition usually causes no symptoms and few, if any, complications. However, some people with NAFLD go on to develop irreversible liver damage that can result in liver failure and cirrhosis. Not enough is known yet to predict exactly who will progress to serious liver disease, but certain risk factors have been identified that may help clinicians fine-tune diagnosis and treatment.

The exact cause of NAFLD is unknown, but its emergence as a recognized and increasingly common disorder coincides with the epidemics of obesity and type 2 diabetes, both of which are associated with insulin resistance. Obesity and insulin resistance, in turn, are implicated in metabolic syndrome, a group of risk factors, including a large waist (in other words, abdominal obesity) and high triglycerides (a type of blood fat), that increase the risk of cardiovascular disease. Some experts consider NAFLD a liver manifestation of metabolic syndrome.

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