Non-Alcoholic Fatty Liver Disease (NAFLD) – The Silent Consequence of Modern Lifestyle

Non-alcoholic fatty liver disease (NAFLD) is an increasingly common chronic liver condition that often remains undetected because it is asymptomatic in its early stages. As emphasized by Tonka Piplović Vuković, MD, MSc, gastroenterology specialist, this condition is closely associated with diet, obesity, and metabolic disorders.

What is Non-Alcoholic Fatty Liver Disease?

Dr. Piplović Vuković explains that NAFLD refers to the accumulation of fat in the liver in individuals who do not consume alcohol in amounts that could cause liver damage.

NAFLD encompasses a spectrum of conditions:

• Simple steatosis – fat accumulation in the liver without inflammation

• Non-alcoholic steatohepatitis (NASH) – fatty liver with inflammation and hepatocyte injury

• Liver fibrosis and cirrhosis – consequences of chronic inflammation

• Increased risk of hepatocellular carcinoma (HCC)

NAFLD is also associated with extrahepatic conditions such as chronic cardiovascular disease, chronic kidney disease, and type 2 diabetes mellitus, as well as other public health–relevant diseases and conditions:

• Adenomatous colon polyps

• Colorectal cancer

• Osteoporosis

• Psoriasis and other inflammatory conditions

Metabolic Syndrome

According to the physician, NAFLD is considered the hepatic manifestation of metabolic syndrome. In addition to fatty liver, metabolic syndrome includes:

• Hyperlipidemia

• Arterial hypertension

• Obesity

• Impaired glucose tolerance, including type 2 diabetes

With the rising prevalence of obesity, the incidence of metabolic syndrome is increasing, which is linked to cardiovascular disease, chronic kidney failure, and type 2 diabetes. Consequently, NAFLD has become the most common chronic liver disease and is projected to become the leading indication for liver transplantation by 2030.

The greater the number of metabolic syndrome components present, the higher the risk of developing and progressing NASH.

How Does NAFLD Develop and Progress?

Dr. Piplović Vuković highlights insulin resistance and altered fatty acid metabolism as central mechanisms. Increased fatty acid influx and synthesis in the liver lead to fat accumulation in hepatocytes. Over time, oxidative stress triggers inflammatory pathways, leading simple steatosis to progress to NASH. Chronic inflammation activates fibroblasts and leads to fibrosis, which can progress to cirrhosis. Cirrhosis carries a significantly increased risk of hepatocellular carcinoma, even in the absence of other classic risk factors.

Abdominal ultrasound as the most common method for confirming the presence of fatty liver.

How is NASH Diagnosed?

Diagnosis of NAFLD is based on non-invasive and, in selected cases, invasive methods.

Non-invasive Diagnostics

This includes liver function tests and assessment of metabolic comorbidities such as obesity, diabetes, and dyslipidemia.

Abdominal ultrasound is recommended as the first-line diagnostic method for detecting fatty liver. Advanced ultrasound software allows grading of steatosis (mild, moderate, severe). At Poliklinika Matulić, the latest Mindray Resona I9 ultrasound system is used for precise and detailed liver assessment.

Liver stiffness assessment is performed using elastography, which detects and monitors liver fibrosis, including cirrhosis.

Invasive Diagnostics

Liver biopsy is performed selectively, as non-invasive methods provide sufficient information in most cases.

Patients with simple steatosis are advised to undergo annual ultrasound follow-up, while those with advanced steatosis and fibrosis require hepatology subspecialist follow-up and semi-annual ultrasound due to the risk of cirrhosis-related complications, including hepatocellular carcinoma.

A comprehensive non-invasive diagnostic workup for NAFLD is available at Poliklinika Matulić.

Treatment and Follow-Up of NAFLD and NASH

The cornerstone of NAFLD treatment is lifestyle modification and management of associated metabolic disorders. Therapy is long-term and individually tailored, as NAFLD and NASH are chronic metabolic diseases.

Mediterranean diet and regular physical activity reduce liver fat.

Lifestyle Modification – The Foundation of Treatment

Gradual and sustained weight loss through diet and regular physical activity is the most important therapeutic step. A Mediterranean-style diet is recommended, including:

• Smaller and more frequent meals

• Vegetables, fruits, whole grains, and fish

• Lean meats such as chicken, turkey, and veal

• Olive oil and nuts

Avoidance of fatty animal products, fast food, refined sugars, and sugary beverages is strongly advised. Even a 7–10% weight loss can significantly reduce liver fat and inflammation and slow disease progression.

Treatment of Metabolic Disorders

Because NAFLD is closely linked to metabolic syndrome, optimal treatment of diabetes, hypertension, and dyslipidemia is essential to reduce the risk of progression to NASH, fibrosis, and cirrhosis.

Pharmacological Therapy – Incretin-Based Medications

There is currently no single medication proven to cure NAFLD. Treatment focuses on managing metabolic syndrome components and reducing liver inflammation.

Research on new therapies targeting insulin resistance, inflammation, and fibrosis is ongoing.

Patient Monitoring

Patients with simple steatosis should undergo annual ultrasound monitoring, while those with advanced disease and fibrosis require more frequent hepatology follow-up due to the risk of cirrhosis and hepatocellular carcinoma.

Bariatric Surgery in NAFLD Treatment

Severe obesity, particularly class III obesity, is strongly associated with NAFLD progression. In patients who do not respond to conservative measures, bariatric surgery may be considered.

Types of Bariatric Procedures

1. Restrictive procedures – reduce stomach volume and food intake

2. Malabsorptive procedures – bypass intestinal segments to reduce nutrient absorption

3. Combined procedures – combine both mechanisms and are most effective long-term

Weight loss after bariatric surgery reduces liver fat, inflammation, and improves metabolic parameters, potentially leading to NASH regression in early stages.

Medical Treatment of Obesity – Incretin-Based Drugs

Obesity is a key risk factor for NAFLD. Incretin-based drugs regulate appetite and glucose metabolism by:

• Stimulating insulin secretion when glucose levels are high

• Reducing glucagon secretion

• Slowing gastric emptying

• Reducing appetite and increasing satiety

These effects lead to weight loss and improved metabolic parameters, positively impacting fatty liver disease. Side effects are usually transient (nausea, vomiting, diarrhea, constipation, bloating). Therapy is introduced gradually.

Contraindications

Absolute contraindications:

• Medullary thyroid carcinoma and MEN2 syndrome

• Pregnancy and breastfeeding

• Drug hypersensitivity

Relative contraindications:

• Severe gastroparesis

• History of pancreatitis

• Severe renal failure

• Concomitant insulin or hypoglycemic therapy

Treatment must be conducted under strict medical supervision.

Why Does the “Yo-Yo Effect” Occur After Stopping Therapy?

Weight-loss medications temporarily modify hunger hormones. After discontinuation, appetite returns, and weight regain is common. Studies show that 50–70% of lost weight may return within one year without lifestyle changes.

How to Prevent Weight Regain

• Increase protein intake

• Eat slowly and mindfully

• Maintain muscle mass with strength training

• Plan long-term weight management

Medications are tools, not magic solutions. Sustainable results require dietary changes, regular physical activity, and healthy lifestyle habits.

Conclusion – Control NAFLD Early

Dr. Piplović Vuković emphasizes that rising obesity and metabolic syndrome make NAFLD a major public health issue. NAFLD is not only a liver disease—it is associated with cardiovascular disease, chronic kidney disease, hypertension, type 2 diabetes, and colorectal cancer.

Lifestyle modification and optimal management of metabolic disorders are crucial to prevent disease progression. NAFLD is a chronic metabolic condition that can be controlled with timely screening, lifestyle changes, and appropriate treatment.

Fatty liver disease often does not cause pain—but the consequences can be serious. Dr. Piplović Vuković advises not to wait for symptoms and to schedule a liver evaluation with the expert team at Poliklinika Matulić.