Nonalcoholic Fatty Liver Disease

Implications for Clinical Practice and Health Promotion

Bethany Croke, FNP-BC; Deborah Sampson, FNP-BC


Journal for Nurse Practitioners. 2012;8(1):45-50. 

In This Article

Abstract and Introduction


Nonalcoholic fatty liver disease (NAFLD), a condition caused by fatty infiltration of the liver, in the absence of large alcohol consumption, that can result in liver failure. It is the leading cause of elevated liver enzymes in adults and of liver disease in children, and it is increasing in the United States commensurately with obesity. Initially an asymptomatic disease, diagnosis is based on risk factor assessment, laboratory findings, and imaging studies. Prevention and early intervention require lifestyle changes. Prognosis is typically good, especially early in the disease course


Nonalcoholic fatty liver disease (NAFLD) is a term for a broad continuum of liver illnesses extending from the rather benign steatosis to the severe cryptogenic cirrhosis.[1–3] Typically, patients with NAFLD have this problem independent of alcohol intake and its effects on the liver. Steatosis, or fatty infiltration of the liver, can progress to nonalcoholic steatohepatitis (NASH). Steatohepatitis, in turn, can progress to permanent liver damage in the form of cirrhosis or malignancy; 3% to 5% of patients with NAFLD progress to NASH, and 15% of those with NASH develop cirrhosis.[4]

NAFLD is the most common cause of elevated liver enzymes in American adults, and its prevalence is anticipated to increase as a result of the American obesity epidemic. Current prevalence estimates are widely regarded as conservative because patients with NAFLD are often asymptomatic, abnormalities are detected inadvertently, and diagnostic tests lack accuracy and noninvasiveness.[5,6] Ninety percent of patients with a body mass index (BMI) of 39 kg per m2 or greater have steatosis, while up to 8.6 million obese Americans may have NASH.[1]

The most significant risk factors for NAFLD include the components of metabolic syndrome: obesity, glucose intolerance or diabetes, hypertension, and dyslipidemia, particularly elevated triglycerides and low levels of HDL cholesterol.[7] NAFLD itself is a risk factor for increased morbidity and mortality, cardiovascular disease and malignancy.[8] Despite these facts, most patients have a good prognosis if the condition is caught in its early stages. Therefore, nurse practitioners (NPs) need to have the knowledge to identify, assess, and treat patients for NAFLD to ensure better patient outcomes.


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