Different stages of NAFLD and management
View(s):Before, venturing into the different stages of NAFLD, Dr. Madunil Niriella reiterates that the corner-stone in the management of this ailment is lifestyle modification.
As trends indicate that in Sri Lanka, the spectrum of NAFLD may overtake alcoholic liver disease, he then focuses on the different stages –
Stage I: Non-Alcoholic Fatty Liver (NAFL) – the earliest form or simple fatty liver which is the accumulation or deposits of fat in the liver without liver-cell injury. This is completely reversible if the doctor’s advice is followed to the letter.
In the community, 80% of NAFLD is NAFL.
Stage II: Non-Alcoholic Steatohepatitis (NASH) — accumulation of fat in the liver with liver-cell injury. This too is completely reversible if the doctor’s advice is followed scrupulously.
In the community, 20% of NAFLD is NASH.
Stage III: Cirrhosis – permanent liver damage due to liver fibrosis (scarring where useless non-functional fibrous tissue forms in the liver).
Stage IV: Complications of NAFLD-related cirrhosis which includes cancer (HCC or haepato-cellular carcinoma).
Issuing a gentle warning that if untreated, 1-2% of NAFL and up to 20% of NASH can progress to cirrhosis over 10-20 years, Dr. Niriella points out that once Stages III and IV (cirrhosis and its complications) are reached, they cannot be reversed.
“Therefore, if NAFL and NASH are detected early, interventions can prevent the progression to cirrhosis,” he adds.
Management of NAFLD
Lifestyle modifications will be the most important interventions, underscores Dr. Niriella, explaining however that it would depend on the stage of the disease.
In NAFL or Stage I, it would be vital for a 5% reduction in the weight of the patient to get rid of the fat deposits in the liver.
In NASH or Stage II, it would be vital for a 10% reduction in the weight to get rid of the fat deposits in the liver as well as the injury caused by these fat deposits.
Both NAFL and NASH are reversible, with simple measures such as:
Adequate, regular physical activity of moderate intensity and reducing the time spent being in a sedentary position – a 30-minute brisk walk five times a week, non-competitive swimming, cycling or racket games.
Controlling the diet –
Reducing the portion size of the food intake, without considering every meal to be an open buffet, as well as cutting out from the diet simple sugars, sugary beverages and desserts. These could be replaced with complex carbohydrates such as rice, but here too the portion size is of paramount importance. The person should ensure that he/she is on a ‘hypocaloric’ diet. This means that if a person’s daily caloric requirement is 2,000 calories, he /she should consume 500 calories less than the requirement.
Replacement of unhealthy saturated fats such as butter, red meats (beef, pork and mutton), full-cream products such as milk, cheese and cream, with mono or polyunsaturated fats such as nuts (peanuts, cashew) and nut oils, olives and olive oil, avocado and oily fish such as salmon. Here too the portions need to be moderate.
Then there will be a weight loss of about ½ a kilo per week.
Two to 4 cups of black, unsweetened coffee per day have been found to be beneficial. No studies have been carried out with regard to tea in this connection.
Avoiding alcohol.
Adequate sleep – at least 8 hours of sleep per day.
Dr. Niriella says that after a trial of lifestyle modifications, the patient needs to be re-assessed through a blood test for liver biochemistry. If progression is good, while maintaining the healthy lifestyle, evaluations of the patient should be done every three to six months.
Rarely, however, if a person does not respond to lifestyle modifications, the option will be drug therapy for NASH or Stage II. Vitamin E would then be prescribed, but warns Dr. Niriella, it should be taken only on medical advice.
Meanwhile, patients suffering from NAFLD should also be screened for metabolic risks and treated for diabetes, hypertension (high blood pressure) and abnormal lipids, he adds.