The leading risk factor for nonalcoholic fatty liver disease NAFLD is being overweight or obese. Yet NAFLD can appear even in people with a normal weight. That is why annual medical checkups and a routine ultrasound of the abdominal cavity are recommended for everyone. In a city clinic in St. Petersburg there are specialists in gastroenterology and hepatology who focus on liver health and NAFLD care.
NAFLD involves fat buildup in the liver accompanied by inflammation and, over time, fibrosis, where healthy liver tissue is replaced with scar tissue. It is most often found in those who are overweight or obese, but it can also occur in individuals who look lean. A person may have a lean or thin appearance yet carry a higher proportion of body fat relative to muscle mass, commonly described as a “skinny fat” profile. This means a low muscle mass paired with higher amounts of subcutaneous and visceral fat, which can encircle the abdominal organs. Abdominal obesity—excess fat in the midsection—also increases the likelihood of NAFLD. People with abdominal fat are more prone to heart disease, diabetes, and dyslipidemia, all of which elevate NAFLD risk. Because of these associations, regular health assessments with abdominal ultrasound are advised, regardless of body weight. [Attribution: Sofya Bakaeva, hepatologist]
One practical sign of abdominal obesity is waist size. A waist circumference above 88 cm in women or above 94 cm in men signals a higher risk of NAFLD and related metabolic issues. For individuals of Asian descent, the thresholds are lower: more than 80 cm for women and more than 90 cm for men. [Attribution: Sofya Bakaeva, hepatologist]
Body mass index BMI is commonly used to assess weight status by dividing weight in kilograms by the square of height in meters. However, BMI has limitations. It does not differentiate between fat and muscle, so athletes or people with unusually high muscle mass may have a higher BMI without excess fat. In such cases, BMI might misrepresent metabolic health. The normal BMI range is 18.5 to 24.9. A BMI of 25 to 29.9 indicates overweight, and a BMI of 30 or higher points to obesity. For people of Asian descent, a BMI above 23 may already indicate overweight, reflecting different body composition patterns. [Attribution: Sofya Bakaeva, hepatologist]
In clinical practice, doctors consider multiple measures to gauge NAFLD risk, including waist measurements, BMI, and other metabolic indicators. The goal is to identify individuals who would benefit from lifestyle changes that reduce liver fat, curb inflammation, and prevent progression to fibrosis. Early evaluation and personalized guidance can help reduce the chance of developing serious liver-related complications. It is important to note that NAFLD is a common condition that can affect people across the weight spectrum, underscoring the value of regular screening and discussions with healthcare providers. [Attribution: Sofya Bakaeva, hepatologist]
Ongoing research continues to clarify how weight loss, dietary patterns, and physical activity influence NAFLD outcomes. Clinicians emphasize that even modest, sustained weight reduction can improve liver fat content and liver function. The emphasis remains on making realistic, long-term changes rather than seeking quick fixes. People are encouraged to work with their healthcare team to tailor strategies that fit their lifestyle, medical history, and cultural context. [Attribution: Sofya Bakaeva, hepatologist]
Finally, the discussion about NAFLD highlights the broader point that liver health reflects overall metabolic well-being. Regular screenings, mindful weight management, balanced nutrition, and physical activity form a practical framework for prevention and early intervention. By staying informed and engaging with healthcare providers, individuals can take proactive steps to protect their liver and their cardiovascular health. [Attribution: Sofya Bakaeva, hepatologist]