Indirect evidence of injury by fat in the liver is reflected by high ALT or AST levels in the blood. The more major form of injury of fatty liver is if the stiffness of the liver starts to increase, which is called fibrosis. Fibrosis can occur even with normal ALT and AST Levels.
The gold standard to measure fibrosis is still liver biopsy. However, liver biopsy carries a risk of bleeding and is an invasive procedure. Alternate indirect evidence can be obtained by doing either a fibroscan or an ARFI or and MR Elastography of the Liver.
Only 5-10% of patients of NAFLD progress to fibrosis. However, once fibrosis develops, a significant proportion of patients can progress to cirrhosis of Liver ( liver becoming stiff and is irreversible). NAFLD is emerging as one of the most common causes of liver cirrhosis after alcohol and viruses like hepatitis B and C.
The answer is again yes. NAFLD can progress to liver cancer even without the development of cirrhosis or fibrosis. The percentage of patients are few and it has been seen that some patients with certain genetic predisposition are more likely to develop the same. We can do an analysis after proper genetic counselling, though you should understand that not all patients with this genetic mutation will progress.
It’s a wrong belief that only obese people have fatty liver. It has been seen that even people with normal weight and even low weight can have NAFLD and many of these are intact possibly genetically predisposed.
Most of the times, patients with NAFLD are accidentally detected during USG testing. Some other patients are detected during evaluation of obesity, fatigue and other diseases.
There are no specific drug treatments yet for either NAFLD or NASH, but a number of lifestyle changes will help considerably!