Non-alcoholic Fatty Liver Disease (NAFLD): NAFL and NASH

NAFLD/NAFL/NASH, What are these conditions?

Non-alcoholic Fatty Liver Disease (NAFLD) is divided into non-alcoholic fatty liver (NAFL) and nonalcoholic steatohepatitis (NASH). Both NAFL and NASH are classified as diseases of the liver but are distinct from one another.  NAFL, also known as fatty liver, is a disease in which fat builds within the cells of the liver (steatosis) in the absence of any significant inflammation or fibrosis (scaring).  NASH, like NAFL, has steatosis, but is associated with significant inflammation and scaring. It is important to note that these conditions are diagnosed only in the absence of all other liver disease, most importantly in the absence of significant alcohol intake.

How is NALFD diagnosed?

Dr. Motola, a NYC Gastroenterologist and Hepatologist, makes a diagnosis of NAFLD using a combination of history taking, physical exam, blood work, and imaging studies to exclude other causes of liver disease. In some patients a liver biopsy may be needed to prove no other condition exists or to more firmly establish the diagnosis of NAFLD.

Why is it important to make the diagnosis of NASH?

It is important to identify patients with NASH  as early as possible because of the risk of progressing to cirrhosis, live failure, and liver cancer.   Although a liver biopsy is the gold-standard for diagnosis clinical history (presence of risk factors), a combination of blood tests, and a special imaging study called a Fibroscan can help determine the extent of liver scarring, which is a sign of underlying inflammation. 

Who is at risk for NALD and how can it be prevented?

There are a variety of individuals who are at risk of developing NAFLD.  Risk factors for NAFLD include obesity, diabetes, high blood pressure, or high cholesterol.   In the United States approximately 30% of the population may have some form of NAFLD, with some studies reporting rates as high as 46%.  NAFLD may be more common in certain ethnicities such as the Hispanic population, due in part to higher rates of obesity. Since, the disease is largely one without symptoms we may not know the exact numbers of people that have it.

Up to 26% of people with NAFLD will have NASH found on biopsy. Of patients diagnosed with NASH the likelihood of developing progressive and advanced scarring increases with increasing numbers of risk factors. This permanent damage to liver cells and accumulated scarring increases the risk of serious liver conditions such as cirrhosis, liver failure, and liver cancer.

The major way that NASH can be prevented is through lifestyle changes to combat the risk factors mentioned above.  It is recommended that exercise be a significant part of the prevention plan.  Also, it is important to maintain a nutritious and healthy eating lifestyle as well.  By exercising and eating a healthy diet, prevention of obesity and the metabolic syndrome is possible.  There is no cure for NASH, thus the key is prevention through lifestyle changes before it becomes a more serious medical condition.

Is there a treatment for NASH?

There have not been any FDA approved treatments for NASH; however, there are new clinical trials becoming increasingly available to volunteers who have the condition. 

Therefore, it is imperative to maintain a healthy lifestyle.  Incorporate exercise, healthy eating and weight loss to prevent the development of this liver disease. Furthermore, maintain a relationship with your healthcare provider in order to get routine health screening for Type II Diabetes Mellitus and other signs of liver or other organ problems.


Disclaimer: This information is intended to educate but not provide treatment or diagnostic information. Self-diagnosis should not be made base on this or any other online information. Please consult with a doctor about your specific condition. Dr. Motola is available for office consultations. A thorough history and physical exam is needed to make accurate diagnosis before treatment provided.

Dr. Motola is a Best in class Gastroenterologist in NYC. For more information about the diagnosis and treatment of fatty liver disease call the office at 212-227-3688 the schedule an appointment with Dr. Motola or conveniently book online via Zocdoc.

Dr. Daniel L. Motola - MD, PhD

Office Locations:

Telephone: 212-227-3688