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Nicole Pajer

Nicole Pajer is a freelance writer published in The New York Times, Parade, AARP, Woman's Day, Men's Journal and beyond.

When she's not writing, she's checking exotic travel destinations off her bucket list, attempting to wear out her 71-pound Doberman's boundless energy and teaching people how to properly pronounce her last name ("It's Pager, just like the beeper!"). Keep up with her adventures on Twitter @NicolePajer.

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Non-Alcoholic Fatty Liver Disease image of liver and symptoms

Non-Alcoholic Fatty Liver Disease

NAFLD is on the rise. Here’s what to know about the disease’s various stages, as well as prevention and treatment guidelines

Created With Support

Medically reviewed by Dr. Erin Spengler

Designed by Megan Schofield

NAFLD: Non-Alcoholic Fatty Liver Disease

  • Occurs when excess fat is stored in the liver
  • The most common form of chronic liver disease in the United States
  • 100 million: The number of U.S. individuals estimated to have NAFLD

The number of NASH cases is projected to increase from 16 million to 27 million by 2030

  • Affects up to 75% of people who are overweight
  • Not caused by excessive alcohol intake

Risk Factors

  • Inactivity
  • Excess weight, especially around the belly
  • High cholesterol, high blood sugar or high triglyceride levels
  • Type 2 diabetes
  • Genetics
  • Rapid weight loss (less common cause)
  • Poor eating habits
  • Underactive thyroid (hypothyroidism)
  • Underactive pituitary gland (hypopituitarism)
  • Polycystic ovary syndrome (PCOS)
  • Sleep apnea


There are often no symptoms of NASH, even at the advanced stages. Some symptoms may include:

Extreme fatigue Pain/discomfort in the upper right abdomen Unexplained weight loss or weakness

Because there are often no symptoms, there is no simple way to diagnose the disease. But research is underway.

The Main Stages of NAFLD

Normal Liver

  • No inflammation or damage to the liver cells

Simple Fatty Liver (Steatosis)

  • Fat in the liver, with little to no signs of inflammation
  • 5% to 10% of the liver’s overall weight is fat

Non-Alcoholic Steatohepatitis (NASH)

  • Advanced stage of NAFLD
  • A biopsy shows fat in the liver, plus inflammation and signs of liver damage
  • 7% to 30% of people with NAFLD will develop NASH

Liver Damage —Fibrosis and Cirrhosis

  • 33% of people with NASH will develop fibrosis, which is scarring of the liver, within 3 years
  • 15% to 25% of people with NASH will develop cirrhosis, which is advanced scarring, and liver damage that prevents the liver from working properly
  • Cirrhosis is the most common reason for a liver transplant

NAFLD and NASH increase your risk of cardiovascular disease, liver cancer and diabetes.

Treatments for NAFLD and NASH

If you are diagnosed with fatty liver in its early stages, you can try to prevent its progression to more advanced stages. Lifestyle changes are the no. 1 recommendation.

Diet changes

  • Reduce sugar, particularly high fructose corn syrup
  • Avoid processed carbohydrates
  • Reduce alcohol use or avoid alcohol completely
  • Eat a healthy diet rich in fruits, vegetables, healthy fats and whole grains

Weight management

  • Get 30 minutes of exercise a day
  • Avoid extreme or yo-yo dieting

Medical intervention

  • There are currently no FDA-approved medications for NASH, but research is underway
  • Medications may be prescribed to help with related issues, like high blood pressure and Type 2 diabetes

This resource was created with support from Pfizer Inc.

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