Low thyroid activity is more prevalent in people with NASH, which would be detected by determining the thyroid-stimulating hormone. PNPLA3 may be relevant for the progression of NAFLD in lean people. , A combination of improved diet and exercise, rather than either alone, appears to best help manage NAFLD and reduce insulin resistance. , Magnetic resonance elastography (MRE) is an emerging method that can accurately assess hepatic fibrosis and is recommended by the APASL.  The Asia-Pacific Work Group advises that Vitamin E may improve liver condition and aminotransferase levels, but only in adults without diabetes or cirrhosis who have NASH. , Weight loss may improve NAFLD and is recommended particularly for obese or overweight people; similar physical activities and diets are advisable for overweight people with NAFLD as for other obese and overweight people. While many treatments appear to improve biochemical markers such as alanine transaminase levels, most do not reverse histological abnormalities or improve outcomes.  NAFLD is a preventable cause of death.  Cirrhosis is found in only about 50% of people with NAFLD and with liver cancer, so that liver cancer and cirrhosis are not always linked.  Studies in experimental animals implicated choline inadequacy in the 1920s in the 1920s and excess sugar consumption in 1949.  Higher levels of intestinal bacteria that produce butyrate may be protective. , People with NAFLD often have no noticeable symptoms, and NAFLD is often only detected during routine blood tests or unrelated abdominal imaging or liver biopsy. Percutaneous liver biopsy remains the most common practice. , Although the disease is commonly associated with obesity, a significant proportion of sufferers are normal weight or lean. , Two-thirds of families with a history of diabetes type 2 report more than one family member having NAFLD.  Several other scores such as FIB-4 score and NAFLD fibrosis score can also reflect the burden of the fibrosis in the liver, and previous studies have confirmed that these score can predict future development of mortality and liver cancer.  Zelman started investigating after observing a fatty liver in a hospital employee who drank more than twenty bottles of Coca-Cola a day. , The primary characteristic of NAFLD is the accumulation of lipids in the liver, largely in the form of triglycerides. Similarly, NASH can include histological features such as portal inflammation, polymorphonuclear cell infiltrates, Mallory bodies, apoptotic bodies, clear vacuolated nuclei, microvesicular steatosis, megamitochondria, and perisinusoidal fibrosis. , For people with NASH and end-stage liver disease, liver failure, or liver cancer, liver transplantation is an accepted procedure according to the EASL. , No medicines specifically for NAFLD or NASH had received approval, as of 2018[update], although anti-diabetic medications may help in liver fat loss. , Treatment with medications is primarily aimed at improving liver disease and is generally limited to those with biopsy-proven NASH and fibrosis.  In some cases, NAFLD can cause symptoms related to liver dysfunction such as fatigue, malaise, and dull right-upper-quadrant abdominal discomfort. Non-alcoholic fatty liver disease (NAFLD), also known as metabolic (dysfunction) associated fatty liver disease (MAFLD), is excessive fat build-up in the liver without another clear cause such as alcohol use. Both correlate with NAFLD presence and severity, but their roles for diagnosis remain unclear.  Furthermore, high fructose consumption promotes fat accumulation in the liver by stimulating de novo lipogenesis in the liver and reducing the beta-oxidation of fat. People with NASH can have elevated levels of blood ethanol and proteobacteria (which produce alcohol), with dysbiosis proposed as a mechanism for this elevation. They consider its effects on improving liver-related complications as unproven yet, but it effectively increases longevity by improving cardiovascular factors. Insulin-resistant skeletal muscle is not as efficient at taking up glucose from the bloodstream after a meal.  Treatment with pentoxifylline is not recommended. , The first acknowledged case of obesity-related non-alcoholic fatty liver was observed in 1952 by Samuel Zelman.  The broader NAFLD term started to be used around 2002.  Coexisting liver diseases, such as hepatitis C and cardiovascular diseases such as atherosclerosis, are also associated with an increased risk of NAFLD.  These FFAs are combined back into triglycerides in the liver, forming the major constituent of the accumulated fat in the liver. 24% in worldwide population, 80% in obese, 20% in normal-weight, This page was last edited on 24 November 2020, at 01:59.  Aerobic exercise may be more effective than resistance training, although there are contradictory results. , The Asia Pacific Working Group guidelines recommend healthcare providers discuss lifestyle modifications before and after transplantation to reduce potential surgery risks and to assist with NAFLD management after the transplant.  In particular, diet diversity may play a role that was overlooked in animal studies, since they often compare a Western high-fat, low-diversity diet against a low-fat but higher-diversity chow. , Disruptions in the intestinal microbiota seem to influence NAFLD risk in several ways. ICD-11 does not use the term NAFL as it was deemed confusing with the family of disorders NAFLD. Chiang H, Lu HF, Chen JC, et al.  Weight loss, through exercise or diet, is the most effective way to reduce liver fat and help NASH and fibrosis remission.  The EASL recommends between 150 and 200 min/week in 3 to 5 sessions of moderate-intensity aerobic physical activity or resistance training. , The majority of normal-weight people affected by NAFLD ("lean NAFLD") have impaired insulin sensitivity, are sedentary, and have increased cardiovascular disease risk and increased liver lipid levels.  Fibrosis in humans with NASH progressed more rapidly than in humans with NAFLD. Nonalcoholic fatty liver disease (NAFLD) is an umbrella term for a range of liver conditions affecting people who drink little to no alcohol. , According to the Asia-Pacific Working Group (APWG) on NAFLD, overnutrition is a major factor of NAFLD and NASH, particularly for lean NAFLD. , Some evidence indicates that maternal undernutrition or overnutrition increases a child's susceptibility to NASH and hastens its progression.