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Nonalcoholic Fatty Liver Disease (NAFLD)

Non-alcoholic fatty liver disease (NAFLD) is an excessive accumulation of fat in the liver that occurs in people who consume little or no alcohol. The condition can range from relatively benign, “simple” fatty liver to more serious non-alcoholic steatohepatitis (NASH), which in some cases can progress to cirrhosis (scarring) and even liver cancer. NAFLD, now the most common chronic liver disease in industrialized countries, is strongly associated with obesity. Gradual weight loss is currently the only safe and effective treatment for NAFLD in people who are overweight.

Risk Factors


People with NAFLD usually do not experience any symptoms. For timely intervention, it is therefore important to know the factors that increase the likelihood of NAFLD. Not surprisingly, these risk factors are similar to those associated with a closely related disorder – the metabolic syndrome.


  • Waist circumference  

  • Body Mass Index (BMI) higher than 25

  • Insulin Resistance

  • Diabetes 

  • Dislipidemia

  • Increasing age


Prediabetes risk factors



Because of the lack of symptoms, NAFLD is most commonly discovered incidentally. Typically, NAFLD is suspected after routine blood work reveals elevated levels of two liver enzymes - aspartate aminotransferase, AST and alanine aminotransferase, ALT. Produced by the liver cells, these enzymes are excreted in large amounts into the blood when cell damage occurs. Ultrasound imaging is widely used to evaluate levels of fat accumulation in the liver. Detailed medical history and additional blood tests are often needed to rule out other common causes of fatty liver, such as alcohol abuse, viral infections (hepatitis C) or certain drugs (tamoxifen, steroids, amiodarone). For definitive diagnosis, liver biopsy may be required.



There are currently no approved pharmacological therapies for NAFLD. Treatment focuses on addressing medical conditions that often co-occur with NAFLD, such as obesity, diabetes and dyslipidemia. Healthy diet and increase in physical activity play a crucial role in effective management of NAFLD.

Lifestyle Medicine

Healthy Diet for Weightloss


Gradual weight loss of 1-2 lbs (0.5 -1 kg) a week has been shown to be a safe and effective way to not only improve liver health but to also reduce one’s overall cardio-metabolic risk. More rapid weight loss may actually lead to the worsening of liver damage.  Instead of trying fad diets that promise quick fixes at the expense of proper nutrition, learn and adopt the principles of healthy eating that may lead to safe, effective and sustainable weight loss.

Weightloss diet to prevent diabetes

Be Physically Active


Physical activity is most often recommended in combination with a healthy diet as a means to achieve weight reduction. However, exercise shows benefits to liver health that are independent of weight loss. It leads to the normalization of the liver enzymes, as well as modulation of liver fat. In addition, physical activity positively affects several risk factors associated with NAFLD. It improves insulin sensitivity and dyslipidemia and lowers one’s risk of developing diabetes.

Physical activity to prevent diabetes

Improve your Blood Lipids 


Lipids have important and varied physiological functions. They serve as an integral part of cell membranes, as an energy source, as enzyme helpers or co-factors and as signaling molecules that affect vital cellular processes, such as growth or survival. However, when present in excess in blood, some lipids, namely triglycerides and cholesterol, can lead to serious cardiovascular complications such as heart disease, heart attack or stroke.

How to use glycemic index and load


Omega-3 to Lower Triglycerides


High levels of triglycerides in the blood are strongly associated with NAFLD.  In addition, levels of triglycerides are closely related to the severity of the disease. Omega-3 polyunsaturated fatty acids, particularly eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) found in fatty fish, are proven to lower the level of triglycerides in the blood and are considered to be heart healthy. Unfortunately, a typical Western diet is deficient in omega-3 fatty acids.

Fiber to Address Multiple Risk Factors 


Dietary fiber is a diverse group of plant materials that cannot be broken down (digested) by human enzymes or absorbed in the small intestine. High-fiber diets have a multitude of health benefits. Fiber helps with weight loss, contributes to cardiovascular and gastrointestinal health, normalizes cholesterol and blood glucose. Many of these health gains are a result of the effect that dietary fiber has on enriching and maintaining good bacteria in the gut.

Psyllium for treatment of prediabetes

Last updated: May 16, 2018

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