Non-alcoholic fatty liver disease

Together with that of obesity, the prevalence of non-alcoholic fatty liver disease is increasing. NAFLD is associated with insulin resistance and participate to the metabolic syndrome. A proportion of NAFLD patient will present a progressive disease characterized by, in addition to steatosis, hepatocellualr damage, chronic inflammation and progressive fibrosis and termed non-alcoholic steatohepatitis (NASH). NAHS is recognized as the hepatic complication of the metabolic syndrome. Its severity is related to fibrosis progression. Pathophysiological mechanisms underlying NASH remain ill-defined, the tools to identify NAFLD patients at risk for NASH progression and validate therapy are lacking. In this review, we concentrate on 2 aspects of NAFLD/NASH pathogenesis: the mechanisms of hepatic insulin resistance and the determinants of fibrosis in the context of metabolic syndrome.