August 12, 2020

Think you’re in the clear with liver health if you don’t imbibe? That’s not necessarily the case with NAFLD. Here’s why.


The liver has many functions that are vital for the body’s survival. One of them is filtering out toxins — therefore, overconsumption of alcohol can overwhelm the liver and damage it. If you’re a teetotaler or someone who drinks very little beer, wine, or liquor, that’s great. You’re helping your liver. But another factor could be harming it, one that many people aren’t aware of: The liver can also experience inflammation and damage if we’re carrying extra weight. The condition is called non-alcoholic fatty liver disease and it can progress to cirrhosis and liver failure.

“The mechanisms are not 100% understood, but it has to do with the fat deposits that occur within the liver tissue,” says Lea K. Matsuoka, M.D., associate professor of surgery in the Division of Hepatobiliary Surgery and Liver Transplantation at Vanderbilt University Medical Center.

It is important to note that lifestyle changes like weight loss can halt or even reverse fatty liver disease in its early stages.


What is non-alcoholic fatty liver disease?

Some fat deposits in the liver are normal, but accumulating too much fat will create non-alcoholic fatty liver disease. When these extra fat deposits cause inflammation or swelling to the organ, the person has non-alcoholic steatohepatitis. When the inflammation and swelling create irreversible damage and scarring, the disease has progressed to cirrhosis.

“Fatty liver disease is a spectrum,” Matsuoka explained. “It’s important to identify people who are at risk for fatty liver disease or who have fatty liver disease and hopefully intervene so that it doesn’t progress to non-alcoholic steatohepatitis or cirrhosis.” It’s also asymptomatic in its early stages, and that’s why maintaining or trying to reach a healthy weight is just as important as other measures to address liver health.

“If you start having symptoms of liver disease, by that time you’re usually cirrhotic or you usually have end-stage liver disease,” Matsuoka said. “So you don’t want to wait until that happens.”

Treatment for NAFLD

Because there are no medications or procedures to treat non-alcoholic fatty liver disease, weight loss is the best defense for healing the liver. Although exercise can help with shedding pounds, Matsuoka recommends focusing on healthy eating and diets. “Diets are hard,” she said, “and so you have to find a diet that you’re going to stick to, and everyone’s a little different.” She often mentions the Mediterranean diet to her patients because it has helped people with fatty liver disease. “That’s what I recommend they look up,” she said, “but with the caveat that it has to work for them and their lifestyle because otherwise they just won’t do it.”

Matsuoka says that weight isn’t an easy topic to discuss, and that many patients with fatty liver disease have already tried to lose weight and may be frustrated with their experience. Her goal is to approach it as she would any other health issue. “We’re going to work on weight loss as an attempt to modify your disease processes.”

A note about children and NAFLD

Liver health is crucial at any age, and Matsuoka said she has seen fatty liver disease in children. “When you’re a child, your diet is not entirely controlled by yourself,” she explained. “It’s controlled by your parents. If the parents start to make dietary changes for their health, it will also impact the health of their children. And then they also learn better eating habits early on.”

If you have risk factors for fatty liver disease, it’s helpful to talk to your primary care provider about how to quit smoking, lose weight or take other steps to avoid liver damage. Vanderbilt Primary Care providers are trusted partners in your health and well-being. If you’re struggling to lose weight, the Vanderbilt Weight Loss Center can help.