Fatty Liver (NAFLD To NASH)

Etiology

  • Non-alcoholic Fatty Liver Disease (NAFLD) is related to fat deposition in liver, which is related to elevated BMI
  • NAFLD also linked to metabolic syndrome (elevated TGs, central adiposity, low HDL, high BP, elevated sugar)
  • Estimated ~25% of US adults have NAFLD
  • ~25% of patients w/NAFLD will progress to Non-Alcoholic Steatohepatitis (NASH), where there is hepatocyte destruction and fibrosis
  • ~25% of those w/NASH will develop cirrhosis, ~30% of whom will develop decompensated dz at 8y, and a small % will develop HCC (over years)
  • Risk of progression related to degree of deposition, duration, host factors, other concurrent exposures (e.g. Hep C, ETOH, etc)

Risk Factors

  • For NAFLD: obesity, diabetes, hypertension, hyperlipidemia, PCOS, OSA, age, genetics, other

Symptoms

  • NAFLD is typically asymptomatic; NASH also asymptomatic until/unless findings of cirrhosis w/portal htn and/or HCC
  • With NAFLD, major cause of morbidity/mortality is cardiovascular disease, so might have symptoms from that
  • Liver related symptoms (and disease) can develop more quickly if coexistent liver insult (e.g. ETOH)
  • Over years, if cirrhosis develops, may develop typical findings of portal htn and advanced liver dz: ascites, jaundice, fatigue, confusion, bleeding, etc.

Physical Exam Findings

  • Elevated BMI
  • In asymptomatic phase, may have painless hepatomegaly
  • If cirrhosis develops, can have typical findings of: jaundice, ascites, edema, spiders, gynecomastia, icterus, splenomegaly, etc.

Tests