Alcohol abuse isn't the only way to get liver disease. Family history, diabetes, and an unhealthy diet can lead to nonalcoholic fatty liver disease.

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Fatty liver disease is just what it sounds like, the buildup of fat inside your liver cells. Fatty liver disease can be caused by alcohol abuse, especially binge drinking. If alcohol is the main cause, it is called alcoholic fatty liver disease. More commonly, fatty liver is caused by metabolic syndrome, in which case it is called nonalcoholic fatty liver disease, or NAFLD.

What Is Metabolic Syndrome?

Metabolic syndrome is a combination of conditions that include belly fat, high blood pressure, high blood sugar, high levels of a blood fat called triglyceride, and low levels of healthy cholesterol called HDL cholesterol. Metabolic syndrome is increasing in America, so it is not surprising that nonalcoholic fatty liver disease is also increasing. In addition to fatty liver, metabolic syndrome increases your risk for heart disease, stroke, and diabetes.

People with metabolic syndrome tend to be overweight and about 80 percent of people that are severely overweight have nonalcoholic fatty liver disease. You may be at higher risk for metabolic syndrome and nonalcoholic fatty liver disease if you have these risk factors:

• Older age
• African American of Mexican ethnicity
• Obesity
• A family history of diabetes
• Smoking
• Drinking alcohol
• High-fat diet
• Inactive lifestyle

What Happens to Your Liver With Nonalcoholic Fatty Liver Disease?

The buildup of fat in your liver is just the first stage of fatty liver disease. This stage can last for many years and it can be revered with lifestyle changes. In about 10 to 20 percent of fatty liver disease, the liver cells become further damaged by inflammation. At this stage the disease is called nonalcoholic associated steatohepatitis or NASH. Steatohepatitis means fatty inflammation. NASH may still be reversible with lifestyle changes but if these changes are not made, the inflammation can lead to scarring of the liver, called cirrhosis. Cirrhosis is not reversible and will lead to liver failure.

Nonalcoholic Fatty Liver Disease Symptoms

Nonalcoholic fatty liver disease has been called silent liver disease because it does not cause symptoms. If fatty liver disease becomes NASH you may start to have symptoms of liver damage. These can include:

• Yellowing of the skin and eyes
• Dark urine
• Loss of appetite, nausea, and weight loss
• Broken blood vessels beneath the skin
• Itching
• Fatigue and weakness

Nonalcoholic Fatty Liver Disease Diagnosis and Treatment

Because nonalcoholic fatty liver disease has no symptoms or warning signs, the diagnosis is usually suspected when routine blood tests of liver function show changes, or an imaging study of the liver done for another reason shows fat.

If you have metabolic syndrome, your doctor may order liver blood tests or an imaging study using sound waves (ultrasound) to look for possible nonalcoholic liver disease or NASH. Further testing may include more blood tests and imaging studies, but the surest way to diagnose fatty liver disease is with a liver biopsy.

There is no treatment needed or available for nonalcoholic fatty liver disease other than lifestyle changes. Some medications are being studied for NASH, but none have been approved and there is no cure for NASH. The best treatment for NASH is also lifestyle changes. These include

• Losing weight
• Getting daily exercise
• Avoiding alcohol
• Eating a healthy diet to lose weight and increase your good cholesterol

Other treatments may be done for metabolic syndrome. These may include taking medication to lower your triglycerides, blood pressure, and blood sugar if needed. The best diet for fatty liver is a Mediterranean diet with more fruits and vegetables, whole grains, nuts, lean meats, olive oil, and less red meat, salt, and sugar.

Learn more about how to follow the Mediterranean diet.

You could be living with nonalcoholic fatty liver disease right now or you could be at risk. Getting all the risk factors under control now is the best way to prevent a fatty liver or to reverse a fatty liver you already have. If you have any of the risk factors, talk to your doctor about a plan to avoid any long-term liver damage.