Context:

Recently, the Union Health Ministry released the revised Operational Guidelines and Training Module of Non-Alcoholic Fatty Liver Disease (NAFLD).

About Non- alcoholic Fatty Liver Disease (NAFLD)

• NAFLD (also referred to as metabolic dysfunction-associated steatotic liver disease, or MASLD) is the accumulation of extra fat in liver cells that is not related to alcohol consumption.
• It can progress to serious conditions like liver inflammation, fibrosis, cirrhosis, and even liver cancer. 
• While it’s normal for the liver to have some fat, having more than 5-10% of the liver's weight as fat is considered a fatty liver (steatosis). 
• NAFLD is the most common chronic liver disease in the world, affecting about 25% of people globally. 

Status of NAFLD

• The prevalence of NAFLD in India ranges from 9% to 32%, which means that 1 to 3 out of every 10 people may have fatty liver or a related condition. 
• India became the first country to integrate the NAFLD in the National Programme for Prevention and Control of NCDs in 2021.

Types of NAFLD:

Nonalcoholic Fatty Liver (NAFL): 

• Also known as Metabolic Dysfunction-Associated Steatotic Liver (MASL).
• This is a milder form of NAFLD with fat present but little to no inflammation or damage to liver cells. 
• Generally, it does not lead to liver damage or complications. However, it can cause pain from enlargement of the liver. 

Nonalcoholic Steatohepatitis (NASH): 

• Also known as Metabolic Dysfunction-Associated Steatohepatitis (MASH).
• This is a more serious form of NAFLD, where fat builds up in the liver along with inflammation and damage to liver cells. 
• NASH can lead to oxidative stress and an immune response, causing further inflammation and fibrosis, increasing the risk of serious complications like cirrhosis and liver cancer.
• People usually develop one type of NAFLD at a time.
• However, it's possible for someone diagnosed with one type to later be diagnosed with the other type. 

Symptoms:

• Usually, nonalcoholic fatty liver disease (NAFLD) is a silent disease with few or no symptoms.
• If one develops cirrhosis from NASH, they may include:
• Fatigue
• Discomfort in the upper right side of the abdomen
• Enlarged spleen

Causes of NAFLD:

• Being overweight or obese increases the risk of NAFLD.
• Conditions like insulin resistance or type 2 diabetes raise the likelihood of NAFLD.
• High triglycerides or unhealthy cholesterol levels can contribute to NAFLD.
• Having three or more traits of metabolic syndrome increases your chances of developing NAFLD.
• Certain genes may make you more prone to NAFLD, which can vary among racial and ethnic groups.
• Diets high in fructose, often found in sweetened foods and drinks, may raise the risk of NAFLD.

Treatment:

• No medications are currently approved for NAFLD, it is mainly treated through lifestyle changes. 
• Losing weight and making healthy food choices can help reduce liver fat and inflammation, while doctors can treat complications from NASH with medications, procedures, or surgery, and severe cases may need a liver transplant.