What is Nonalcoholic Fatty Liver Disease?

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Nonalcoholic Fatty Liver Disease (NAFLD) is the most common cause of chronic liver disease, affecting 25% of people worldwide. It recently received new attention since for the first time the American Diabetes Association (ADA) included recommendations on how to prevent, diagnose, and manage liver disease in their 2022 Standards of Care. The ADA has also collaborated with the American Gastroenterological Association to raise global awareness about the increasing incidence of NAFLD.

What is NAFLD?

NAFLD is an umbrella term for a range of liver diseases that will become more severe over time if people don't make changes in their food choices and physical activity levels. In NAFLD, fat builds up in the liver without inflammation or changes to the liver cells themselves. 

NAFLD can progress to Nonalcoholic Steatohepatitis (NASH) when fat in the liver reaches at least 5% and scar tissue known as fibrosis starts to appear in the liver cells. Without treatment, NASH will progress to cirrhosis and is also linked to liver cancer. NASH is the second most common reason for liver transplants in the United States after hepatitis C. The good news: with treatment to reduce inflammation, NASH can revert back to NAFLD.

Cirrhosis is permanent scarring and damage in the liver, where scar tissue replaces healthy tissue so that liver function decreases. Cirrhosis can cause liver failure and is linked with liver cancer.

NAFLD and Diabetes:

Since the 1980s, the number of people with type 2 diabetes (T2DM) diagnosed with NAFLD has increased steadily. More than 60% of people with T2DM are estimated to have NAFLD, and 30-50% could have NASH. Excess body fat, especially in the midsection, increases risk for NAFLD. Additional causes of NAFLD include chronically high blood sugar levels, low HDL cholesterol, high LDL cholesterol, high triglycerides, and high blood pressure. 

NAFLD is not associated with excessive alcohol intake. However, women with polycystic ovarian syndrome (PCOS) are at increased risk of both T2DM and NAFLD due to insulin resistance.

To learn more about NAFLD, visit the post Nonalcoholic Fatty Liver Disease: Diagnosis and Treatment.

By Lynn Grieger, RDN, CDCES, CPT, CHWC


  1. DiaTribe Learn. Maintain the Health of Your Liver: Latest ADA Standards of Care. Hope Warshaw. https://diatribe.org/maintain-health-your-liver-latest-ada-standards-care  accessed 6-5-22; published 5-16-22.
  2. American Diabetes Association Professional Practice Committee; 4. Comprehensive Medical Evaluation and Assessment of Comorbidities: Standards of Medical Care in Diabetes—2022Diabetes Care 1 January 2022; 45 (Supplement_1): S46–S59. https://doi.org/10.2337/dc22-S004
  3. Cusi K, Isaacs S, Barb D, Basu R, Caprio S, Garvey WT, Kashyap S, Mechanick JI, Mouzaki M, Nadolsky K, Rinella ME, Vos MB, Younossi Z. American Association of Clinical Endocrinology Clinical Practice Guideline for the Diagnosis and Management of Nonalcoholic Fatty Liver Disease in Primary Care and Endocrinology Clinical Settings: Co-Sponsored by the American Association for the Study of Liver Diseases (AASLD). Endocr Pract. 2022 May;28(5):528-562. doi: 10.1016/j.eprac.2022.03.010. PMID: 35569886.
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