Non-Alcoholic Fatty Liver Disease (NAFLD/NASH)

Non-alcoholic fatty liver disease, or NAFLD, happens when fat builds up in your liver even though you drink little or no alcohol. Your liver normally contains some fat, but when more than 5 to 10 percent of your liver weight is fat, it becomes a health concern. NAFLD is now one of the most common liver conditions in the United States, affecting roughly 25 percent of adults.

NAFLD exists on a spectrum. Simple fatty liver, the milder form, causes little harm on its own. But when inflammation and cell damage develop alongside the fat, the condition progresses to non-alcoholic steatohepatitis, or NASH. NASH can lead to scarring of the liver, called fibrosis, and eventually cirrhosis or liver failure if left unmanaged.

The good news is that NAFLD often responds well to lifestyle changes. Losing weight, eating better, and moving more can reduce liver fat and inflammation. Catching the condition early through blood testing gives you the chance to reverse damage before it becomes permanent.

Many people with NAFLD have no symptoms, especially in the early stages. As the disease progresses, you might notice:

• Fatigue or feeling tired all the time
• Discomfort or aching in the upper right side of your abdomen
• Unexplained weight loss
• Weakness
• Yellowing of the skin or eyes, called jaundice
• Swelling in the abdomen or legs
• Confusion or difficulty thinking clearly

Most people with NAFLD discover they have it through routine blood work or imaging, not because of symptoms. This makes regular testing important, particularly if you have risk factors like obesity or diabetes.

NAFLD develops when your liver stores too much fat, often linked to insulin resistance. When your cells stop responding well to insulin, your liver increases fat production and struggles to break down existing fat. Obesity, especially excess belly fat, is the strongest risk factor. Type 2 diabetes, prediabetes, high cholesterol, high triglycerides, and metabolic syndrome all increase your risk significantly.

Diet quality matters too. Eating too many refined carbohydrates, added sugars, and omega-6 fatty acids while getting too few omega-3 fatty acids promotes liver inflammation. This imbalanced fatty acid ratio creates an environment where fat accumulates and inflammatory chemicals damage liver cells. Other risk factors include polycystic ovary syndrome, underactive thyroid, sleep apnea, and certain medications like steroids or tamoxifen.

Doctors diagnose NAFLD through a combination of blood tests, imaging, and sometimes liver biopsy. Liver enzyme tests like ALT and AST can show liver inflammation, though they are not always elevated in NAFLD. Imaging such as ultrasound, CT scans, or MRI can reveal fat in the liver. Advanced tests like FibroScan measure liver stiffness to assess fibrosis without a biopsy.

Blood tests that measure nutritional risk factors play an important role in NAFLD management. The omega-6 to omega-3 ratio reveals whether your diet promotes liver inflammation and fat accumulation. A high ratio indicates too many pro-inflammatory fats and too few protective fats, both of which contribute to liver damage. Rite Aid offers testing for omega-6/omega-3 ratio as an add-on to our flagship panel, available at Quest Diagnostics locations nationwide. Testing this biomarker helps you understand your dietary risks and guides specific changes to protect your liver.

Treatment for NAFLD focuses on reducing liver fat and inflammation through lifestyle changes and addressing underlying conditions.

• Lose weight gradually if you are overweight, aiming for 7 to 10 percent of your body weight
• Eat a Mediterranean-style diet rich in vegetables, fruits, whole grains, and healthy fats
• Increase omega-3 fatty acids from fatty fish, walnuts, and flaxseeds
• Reduce omega-6 fatty acids by limiting vegetable oils, fried foods, and processed snacks
• Cut back on added sugars, especially fructose from sugary drinks and sweets
• Exercise regularly, aiming for 150 minutes of moderate activity per week
• Control blood sugar if you have diabetes or prediabetes
• Manage cholesterol and triglyceride levels
• Avoid alcohol completely, as it adds stress to your liver
• Work with your doctor to manage medications that might affect your liver

No medications are specifically approved for NAFLD yet, but your doctor may prescribe treatments for related conditions like diabetes or high cholesterol. Vitamin E and pioglitazone show promise in some studies but are not right for everyone. Regular monitoring through blood tests helps track your progress.