[Non-alcoholic fatty liver disease--new view]

Area of Science:

• Hepatology
• Metabolic Disorders
• Gastroenterology

Context:

• Non-alcoholic fatty liver disease (NAFLD) encompasses a range of liver conditions, from simple steatosis to non-alcoholic steatohepatitis (NASH), cirrhosis, and liver cancer.
• NAFLD is strongly associated with visceral adiposity, obesity, type 2 diabetes mellitus (DM t.2), and metabolic syndrome.
• Pathogenesis involves overnutrition, inactivity, insulin resistance (IR), and genetic factors, with IR playing a central role.

Purpose:

• To review the pathogenesis, clinical presentation, and therapeutic challenges of NAFLD/NASH.
• To highlight the significant prevalence and progressive nature of NAFLD.
• To discuss current and potential therapeutic strategies focusing on risk factor modification.

Summary:

• NAFLD affects 17-33% of populations, with NASH present in one-third of cases and 20-25% progressing to cirrhosis.
• Early stages are often asymptomatic, marked by elevated liver enzymes and fatty changes on ultrasound.
• The disease is not benign, with significant rates of fibrosis progression, cirrhosis development, and liver-related mortality over 10 years.

Impact:

• NAFLD is a leading cause of unexplained elevation in liver tests.
• Effective treatments are lacking, emphasizing lifestyle modifications like diet and exercise to improve insulin sensitivity and manage weight.
• Metformin is commonly used, but other agents are under investigation; NASH recurrence post-transplant is a concern.