Viral Hepatitis and Liver Disease Website Course

Evaluating Liver Test Abnormalities

Understanding the Pathophysiology of Liver Disease

for Health Care Providers

Non-Alcoholic Fatty Liver Disease (NAFLD) Including Non-Alcoholic Steatohepatitis (NASH) - Non-Alcoholic Fatty Liver

Back to Chronic Hepatocellular Injury


Non-alcoholic fatty liver disease (NAFLD) is a metabolic syndrome which is frequently seen in the setting of obesity, hyperlipidemia and diabetes. A subset of patients, non-alcoholic steatohepatitis (NASH) has a progressive course and may lead to cirrhosis.


The diagnosis of NAFLD is a diagnosis of exclusion and is made on clinical grounds. In the absence of any other causes of chronic liver disease, the coexistence of the metabolic syndrome (obesity, hyperlipidemia, diabetes, hypertension) support the diagnosis.

Physical examination

There are no physical findings specific for NAFLD. Obesity may be evident, but its absence does not preclude the diagnosis.

Other Investigation

Hyperferritinemia is frequently seen. However, this finding is not specific to NAFLD/NASH. Ultrasound, CT scan and MRI are sensitive in detecting the presence of fat in the liver. However, they are not useful in detecting the presence of inflammation.

Liver biopsy is the only method that can provide a definitive diagnosis of NASH. Nevertheless, biopsy is not generally indicated since there is currently no effective treatment for NASH. Prior to proceeding to biopsy, an empirical trial of weight loss, diet and exercise should be attempted in patients with suspected NASH. Treatment for dyslipidemia should also be considered.

In addition to laboratory investigations directed at determining a possible etiology of chronic hepatocellular injury, platelets, albumin and prothrombin time/INR should be obtained. The presence of the following is suggestive of cirrhosis:

  • Thrombocytopenia, hypoalbuminemia or prolonged prothrombin time/INR