Fatty liver and nonalcoholic steatohepatitis. Where do we stand and where are we going?

Fatty liver (FL) is the most common liver disease but its clinical significance remains elusive. Nonalcoholic steatohepatitis (NASH) is increasingly recognized as a cause of liver failure, sometimes recurring following transplantation. Recent data on both conditions are critically reviewed.

A Medline search of the medical literature (1990 to September 1998) and cross-references was performed.

FL most commonly affects middle-aged men with obesity, altered glucose metabolism, hyperlipidemia, and hypertension. The link between biology of HCV, iron metabolism and FL should be addressed. Prospective studies should also quantify the rate and the factors involved in the progression of FL to NASH. The clinical spectrum of NASH is currently broader than it was initially recognized. Diagnosis of FL and NASH may involve ultrasonography, liver biopsy, and recognition of related conditions. Treatment of these conditions must be tailored according to patient's features.

The clinical significance of FL is incompletely understood at present. The relationship, if any, of FL and the metabolic syndrome should be carefully investigated.