Symptoms

NAFLD usually causes no signs and symptoms. When it does, they may include:

• Fatigue
• Pain or discomfort in the upper right abdomen

Possible signs and symptoms of NASH and advanced scarring (cirrhosis) include:

• Abdominal swelling (ascites)
• Enlarged blood vessels just beneath the skin's surface
• Enlarged spleen
• Red palms
• Yellowing of the skin and eyes (jaundice)

Causes

Experts don't know exactly why some people accumulate fat in the liver while others do not. Similarly, there is limited understanding of why some fatty livers develop inflammation that progresses to cirrhosis.

NAFLD and NASH are both linked to the following:

• Overweight or obesity
• Insulin resistance, in which your cells don't take up sugar in response to the hormone insulin
• High blood sugar (hyperglycemia), indicating prediabetes or type 2 diabetes
• High levels of fats, particularly triglycerides, in the blood

These combined health problems appear to promote the deposit of fat in the liver. For some people, this excess fat acts as a toxin to liver cells, causing liver inflammation and NASH, which may lead to a buildup of scar tissue in the liver.

Risk factors

A wide range of diseases and conditions can increase your risk of NAFLD, including:

• High cholesterol
• High levels of triglycerides in the blood
• Metabolic syndrome
• Obesity, particularly when fat is concentrated in the abdomen
• Polycystic ovary syndrome
• Sleep apnea
• Type 2 diabetes
• Underactive thyroid (hypothyroidism)
• Underactive pituitary gland (hypopituitarism)

NASH is more likely in these groups:

• Older people
• People with diabetes
• People with body fat concentrated in the abdomen

It is difficult to distinguish NAFLD from NASH without further testing.

Complications

The main complication of NAFLD and NASH is cirrhosis, which is late-stage scarring in the liver. Cirrhosis occurs in response to liver injury, such as the inflammation in NASH. As the liver tries to halt inflammation, it produces areas of scarring (fibrosis). With continued inflammation, fibrosis spreads to take up more and more liver tissue.

If the process isn't interrupted, cirrhosis can lead to:

• Fluid buildup in the abdomen (ascites)
• Swelling of veins in your esophagus (esophageal varices), which can rupture and bleed
• Confusion, drowsiness and slurred speech (hepatic encephalopathy)
• Liver cancer
• End-stage liver failure, which means the liver has stopped functioning

Between 5% and 12% of people with NASH will progress to cirrhosis.

Prevention

To reduce your risk of NAFLD:

• 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.

Diagnosis

Because NAFLD causes no symptoms in most cases, it frequently comes to medical attention when tests done for other reasons point to a liver problem. This can happen if your liver looks unusual on ultrasound or if you have an abnormal liver enzyme test.

Tests done to pinpoint the diagnosis and determine disease severity include:

Blood tests

• Complete blood count
• Liver enzyme and liver function tests
• Tests for chronic viral hepatitis (hepatitis A, hepatitis C and others)
• Celiac disease screening test
• Fasting blood sugar
• Hemoglobin A1C, which shows how stable your blood sugar is
• Lipid profile, which measures blood fats, such as cholesterol and triglycerides

Imaging procedures

Imaging procedures used to diagnose NAFLD include:

• Abdominal ultrasound, which is often the initial test when liver disease is suspected.
• Computerized tomography (CT) scanning or magnetic resonance imaging (MRI) of the abdomen. These techniques lack the ability to distinguish NASH from NAFLD, but still may be used.
• Transient elastography, an enhanced form of ultrasound that measures the stiffness of your liver. Liver stiffness indicates fibrosis or scarring.
• Magnetic resonance elastography, works by combining MRI imaging with sound waves to create a visual map (elastogram) showing the stiffness of body tissues.

Treatment

The first line of treatment is usually weight loss through a combination of a healthy diet and exercise. Losing weight addresses the conditions that contribute to NAFLD. Ideally, a loss of 10% of body weight is desirable, but improvement in risk factors can become apparent if you lose even 3% to 5% of your starting weight. Weight-loss surgery is also an option for those who need to lose a great deal of weight.

For those who have cirrhosis due to NASH, liver transplantation may be an option.

Lifestyle & home remedies

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. Calorie reduction is the key to losing weight and managing this disease.
Choose a healthy diet. Eat a healthy diet that's rich in fruits, vegetables and whole grains, and keep track of all calories you take in.
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. 
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.  

Alternative medicine

No alternative medicine treatments are proved 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.

Coffee. In studies of people with nonalcoholic fatty liver disease, those who reported drinking two or more cups of coffee a day had less liver damage than those who drank little or no coffee. It's not yet clear how coffee may influence liver damage, but findings suggest it may contain certain compounds that may play a role in fighting inflammation.

References:

https://en.wikipedia.org/wiki/Fatty_liver_disease

https://www.nutreance.com/products/hepagard?

https://www.healthline.com/nutrition/fatty-liver

https://www.nhs.uk/conditions/non-alcoholic-fatty-liver-disease/

https://medlineplus.gov/fattyliverdisease.html

https://www.mayoclinic.org/diseases-conditions/nonalcoholic-fatty-liver-disease/diagnosis-treatment/drc-20354573

https://www.webmd.com/hepatitis/fatty-liver-disease