Current and future therapeutic strategies in NAFLD

Non alcoholic fatty liver disease (NAFLD) is increasingly diagnosed worldwide and considered to be the commonest liver disorder in Western countries. It comprises a disease spectrum ranging from simple steatosis (fatty liver), through non-alcoholic steatohepatitis (NASH) to fat with fibrosis and ultimately cirrhosis. Simple steatosis is largely benign and non-progressive, whereas NASH, characterized by hepatocyte injury, inflammation and fibrosis can lead to cirrhosis, liver failure and hepatocellular carcinoma (HCC). NAFLD is strongly associated with obesity, insulin resistance, hypertension and dyslipidaemia and is now regarded as the liver manifestation of the metabolic syndrome. Rapid spread of the obesity 'pandemic' in adults and children, coupled with the realisation that the outcomes of obesity-related liver disease are not entirely benign, has led to rapid growth in clinical and basic studies in NAFLD over the past decade. These studies are now beginning to inform management strategies for patients with NAFLD.