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Fatty Liver Disease (NAFLD)

The silent liver disease affecting millions of Nigerians — what you need to know

Non-alcoholic fatty liver disease (NAFLD) — fat accumulation in the liver in people who drink little or no alcohol — has become one of the most common liver conditions in urban Nigeria. Driven by rising obesity, diabetes, and Western dietary patterns, NAFLD affects up to 20–30% of Nigerians in cities. Most people have no symptoms. Without intervention, it can progress to cirrhosis and liver cancer.

Signs and Symptoms

✓ Most people with NAFLD have NO symptoms
✓ Vague right upper abdominal discomfort or heaviness
✓ Fatigue — often the only symptom in early-stage disease
✓ Liver found to be enlarged on examination or ultrasound incidentally
✓ Raised liver enzymes (ALT, AST) found on routine blood tests
✓ In advanced cirrhosis: jaundice, ascites (fluid in abdomen), confusion, easy bruising

Risk Factors

When to Seek Help

Raised ALT or AST on blood testsRequires investigation — liver ultrasound and hepatitis B/C testing to identify the cause.
Fatty liver found on ultrasoundEven if no symptoms, needs assessment and staging to determine if NASH or fibrosis is present.
Type 2 diabetes or obesityAll people with T2DM or BMI above 30 should be screened for NAFLD with LFTs and ultrasound.
Signs of advanced liver diseaseJaundice, swollen abdomen (ascites), or spider naevi — needs urgent hepatology referral.

Tests & Diagnosis

🧪 Liver function tests (LFTs — ALT, AST, GGT, ALP, bilirubin)
ALT is the most sensitive marker of liver cell injury. Raised ALT is often the first sign of NAFLD.
🧪 Liver ultrasound
Shows hepatic steatosis (fat in the liver) as increased echogenicity. Does not detect inflammation or fibrosis.
🧪 FIB-4 score
A calculation using age, ALT, AST, and platelet count — estimates the likelihood of significant liver fibrosis without biopsy. FIB-4 above 2.67 suggests advanced fibrosis.
🧪 Fibroscan (transient elastography)
Measures liver stiffness — a surrogate for fibrosis. Available at some Nigerian hepatology centres. The best non-invasive test for liver fibrosis staging.
🧪 Liver biopsy
The gold standard to grade steatosis, inflammation (NASH), and fibrosis — but invasive. Now reserved for cases where non-invasive tests are inconclusive.
🧪 Hepatitis B and C serology
To exclude viral hepatitis as an alternative or co-existing cause.

Treatment Options

1
Weight loss — the only proven treatment
Losing 7–10% of body weight reduces liver fat, inflammation, and fibrosis. Losing more than 10% reverses significant fibrosis. This is the most powerful treatment available — no drug has matched it.
2
Reduce refined carbohydrates
White rice, white bread, sugary drinks, and sweet snacks drive hepatic fat accumulation. Replace with vegetables, beans, whole grains, and fibre-rich foods.
3
Cut out sugary drinks completely
Fructose (in soft drinks, juice, malt) is metabolised almost exclusively in the liver and directly deposits fat. Eliminating sugary drinks is the highest-yield dietary change.
4
Exercise 150 minutes per week
Aerobic exercise reduces liver fat independently of weight loss. Even without losing weight, 3 months of regular exercise reduces hepatic steatosis measurably.
5
Control diabetes and blood pressure
Tight glycaemic control and treating metabolic syndrome components slow NAFLD progression.
6
Avoid alcohol completely
Even small amounts of alcohol worsen NAFLD and accelerate fibrosis. Abstinence is recommended.
7
Avoid hepatotoxic medications
Minimise ibuprofen and other NSAIDs, and review all supplements and traditional medicines with your doctor — some agbo preparations are hepatotoxic.
8
Vitamin E (800 IU daily)
Evidence supports vitamin E for non-diabetic NASH — reduces liver inflammation. Not for people with cirrhosis or diabetes.

Frequently Asked Questions

Is fatty liver serious?
Most people with simple steatosis (fat alone) will not progress to serious liver disease if they make lifestyle changes. However, about 20% develop NASH (fatty liver with inflammation), and of those, 15–25% develop cirrhosis over 10–20 years. Cirrhosis can cause liver failure and liver cancer. The trajectory depends largely on whether metabolic risk factors are addressed.
Can fatty liver be reversed?
Yes — simple fatty liver is fully reversible with weight loss and dietary changes. Even established NASH and early fibrosis can regress with 7–10% weight loss sustained over 12 months. This is one of the most reversible serious liver conditions.
Is NAFLD the same as alcoholic liver disease?
No — NAFLD occurs without significant alcohol use. Alcoholic liver disease is caused by heavy alcohol consumption. They look similar on imaging and biopsy, which is why drinking history is essential to distinguish them. Both can cause cirrhosis.
Are any medications available for NAFLD?
No drugs are currently approved specifically for NAFLD/NASH globally. Semaglutide (Ozempic) and some other GLP-1 agonists show promise in trials but are not yet approved for this indication. Weight loss, diet, and exercise remain the evidence-based treatment.
Can I take supplements or agbo for fatty liver?
Some herbal supplements marketed for 'liver cleansing' or 'liver health' are hepatotoxic — they worsen liver damage. There is no supplement with proven benefit for NAFLD. Avoid self-treating with traditional preparations. Milk thistle (silymarin) has modest evidence for reducing liver enzymes — discuss with your doctor.

Related Pages

Liver Cancer (Hepatocellular Carcinoma)Hepatitis B Long-Term ManagementObesity Medical GuideType 2 Diabetes Nigeria

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