NAFL, NAFLD and NASH: Similarities and differences

A person’s liver usually contains a small amount of fat. However, non-alcoholic fatty liver disease (NAFLD) is where an individual has excess fat in the liver. It does not result from the consumption of alcohol.

There are two types of NAFLD: non-alcoholic fatty liver disease (NAFL) and non-alcoholic steatohepatitis (NASH).

Weight loss is the only recommended treatment for NAFLD, and there are currently no drugs to treat either condition.

Read on to discover the symptoms, causes and treatments for NAFLD, NAFL and NASH and the differences between the three.

According to the American Liver Foundation (ALF), the liver generally contains a small amount of fat.

However, fatty liver disease occurs when more than 10% of the weight of this organ includes fat.

NAFLD is the most common cause of chronic liver disease in the United States and affects up to 25% of the world’s population.


NAFLD is known as a silent disease, which means that there are usually no symptoms of State.

However, some people may experience symptoms such as:

  • abdominal pain
  • tired
  • jaundice
  • loss of appetite
  • mental confusion
  • nausea
  • swelling of the legs and abdomen
  • weakness
  • weightloss


The ALF estimates that approximately 100 million people in the United States have NAFLD. However, health experts do not fully understand what causes the condition. Studies are continuing, but researchers have concluded that certain health conditions may contribute to the development of NAFLD. A person’s genetic makeup, diet, and digestive system may also play a role.

Health conditions that can make a person more likely to develop NAFLD include:

And although researchers believe that specific genes may contribute to the development of this disease, more studies are needed.

In addition to the above, certain herbal remedies or dietary supplements may caused damage to the liver, so anyone who wants to start taking supplements should always discuss the risks with their doctor.


A person can control or even reverse NAFLD through healthy living, which may involve following a nutritious diet or losing weight. Experts suggest that weight loss can help reduce fat in the liver as well as reduce inflammation and fibrosis.


If healthcare providers suspect a person has NAFLD, NAFL, or NASH, they may order various tests to confirm. These may include:

  • a medical history
  • blood tests
  • imaging exams
  • a liver biopsy

Also known as simple fatty liver, NAFL occurs when there is a buildup of mostly harmless fat in the liver. This is called steatosis.

According to the UK National Health Service (NHS), most people will only develop NAFL and usually won’t realize it.

However, NAFL can progress in some people and cause liver damage.


NAFL does not usually cause inflammation or damage to the liver. However, since the liver may be larger than usual due to extra fat in the cells of the organ, people may experience pain. Usually the NAFL will not progress.


Fatty liver disease is not necessarily due to NAFLD. Doctors may want to consider other diagnoses before choosing NAFLD as the cause of a person’s fatty liver disease.

For example, fatty liver can also be due to:

  • alcohol-related liver disease
  • lose weight too fast
  • take certain medications
  • exposure to toxins
  • Wilson’s disease or other rare genetic diseases


According to National Institute of Diabetes and Digestive and Kidney Diseases, it may be possible to prevent or minimize the risk of developing NAFLD with lifestyle changes.

These include:

  • regular physical activity
  • maintain a moderate weight
  • follow a nutritious diet
  • limit portion sizes

Often losing between 3% and 5% of a person’s body weight can reduce fat in the liver.


Since there are no symptoms, doctors usually only discover NAFL when they perform medical tests for other reasons. For example, a blood test will show elevated levels of liver enzymes. Healthcare professionals may then wish to perform further investigations, such as a complete medical history and physical exams.

If a person has NASH and high levels of fat in the liver, they also suffer from inflammation and liver damage.

This inflammation and damage to the liver can lead to:


Again, there are often no symptoms for NASH, but some people may develop cirrhosis as a complication.

Symptoms of cirrhosis include:

  • be quick to bruise and bleed
  • intense itching
  • jaundice, which refers to yellowing of the eyes and skin
  • spider veins, which are visible blood vessels near the surface of the skin
  • abdominal swelling

It is essential to seek emergency medical attention if a person experiences any of the following symptoms symptoms:

  • fever
  • shortness of breath
  • vomit blood
  • dark or black tarry stools
  • slurred speech and mental confusion

Without treatment, cirrhosis can cause the liver to stop functioning: a range of different health problems can result from liver dysfunction, as it controls many other bodily functions.


The ALF estimates that approximately 20% of people with NAFLD will develop NASH. Older people are also more likely to develop NASH, but some children can get it.

NASH is also more likely occur in people with:

  • overweight or obesity
  • body fat concentrated around the waist
  • insulin resistance or type 2 diabetes
  • high blood pressure
  • obstructive sleep apnea


To reduce liver inflammation and fibrosis, people should aim to lose between 7% to 10% of their body weight. Health experts recommend doing this over time rather than quickly because losing weight too quickly can make liver disease worse.

Doctors can use drugs to treat NASH complications, which may require minor medical procedures or surgery. People with liver failure or liver cancer may need a liver transplant.


A Liver biopsy is the only test capable of diagnosing NASH, as it must show precisely how far the disease has progressed. Liver biopsies can rule out other conditions or give healthcare providers a better view of advanced liver disease or cirrhosis than imaging tests.

NAFL, NAFLD and NASH are connected, in that NAFL and NASH are the two types of NAFLD.

Although NAFL is easily treatable and reversible, NASH can reach a stage where all a person can do is prevent further damage.

Losing weight slowly and steadily is the best treatment for all forms of non-alcoholic fatty liver disease.

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