Recent advances in nonalcoholic fatty liver disease

This review focuses on recent advances in the study of the epidemiology, pathogenesis, natural history and treatment of nonalcoholic fatty liver disease (NAFLD).

Study of hepatic lipid metabolism with respect to the contribution of de-novo lipogenesis to hepatic steatosis and insulin resistance and the dysregulation of cellular adaptive response to stress, that is, the unfolded protein response has added to our current understanding of NAFLD. microRNA has recently emerged and has been shown to be differentially expressed in patients with nonalcoholic steatohepatitis. Its mechanism of action remains to be further explored. There is no proven pharmacotherapy for the treatment of NAFLD. Lifestyle intervention to achieve weight loss and increase exercise is persistently associated with improved liver histology. The diagnostic utility of noninvasive markers and imaging modalities in assessing fibrosis remains to be elucidated.

The underlying mechanism and pathogenesis of NAFLD remain elusive. Although research effort has advanced the understanding of the natural history, pathogenesis and management of the disease, there is no proven therapy for this medical condition. At present, treatment concentrates on managing underlying metabolic risk factors.