Fatty liver: the most effective dietary supplements

Nonalcoholic fatty liver disease (NAFLD) is an excessive accumulation of fat in the liver, affecting more than 5% of hepatocytes without being related to excessive alcohol consumption. This disease encompasses a spectrum of disorders, ranging from simple fat accumulation (steatosis) to a more severe form, nonalcoholic steatohepatitis (NASH), where inflammation and possibly fibrosis develop, potentially progressing to cirrhosis and, in some cases, liver cancer.

Causes and mechanisms

NAFLD is primarily related to obesity, insulin resistance, and metabolic inflammation. These factors lead to an accumulation of fat in the liver, often in the form of triglycerides. If this accumulation is accompanied by inflammation, it can progress to NASH, a more advanced form that can result in hepatic fibrosis, cirrhosis, and sometimes hepatocellular carcinoma. The so-called "two-hit" theory suggests that the first step is fat accumulation, followed by a second factor, such as oxidative stress or inflammation, causing more severe liver injury.

Symptoms

NAFLD is often asymptomatic and discovered incidentally during blood tests or routine imaging. When symptoms are present, they include fatigue, discomfort or pain in the upper right part of the abdomen, as well as abnormal liver enzyme tests. If the disease progresses to NASH, more severe signs such as jaundice (yellowing of the skin), ascites (fluid accumulation in the abdomen), and edema may appear.

Risk factors

The main cause of NAFLD is excess calories, often linked to a diet high in carbohydrates and saturated fats combined with low physical activity. Other risk factors include obesity, type 2 diabetes, hyperlipidemia (high cholesterol), and hypertension. Genetic predispositions may also contribute to the development of the disease.

Complications

About 20% of people with NAFLD develop NASH, a more severe form that can lead to advanced hepatic fibrosis or even cirrhosis. These patients also have an increased risk of liver cancer (hepatocellular carcinoma), as well as cardiovascular disease and type 2 diabetes.

Treatment

Treatment is essentially based on lifestyle modifications, as no specific medication has yet been approved to treat NAFLD. Weight loss is a key element: a 7–10% reduction from initial body weight can improve steatosis, reduce inflammation, and slow the progression of fibrosis. A balanced diet low in sugars and saturated fats and rich in omega-3 fatty acids is recommended. It is also advised to limit sugary drinks and sodas. Regular physical activity, such as 150 minutes of moderate exercise per week, can help reduce steatosis and promote weight loss. It is also essential to control other metabolic risk factors, such as hypertension, type 2 diabetes, and cholesterol problems. Contrary to some misconceptions, statins can be used safely to manage dyslipidemia in patients with fatty liver.