Non-alcoholic fatty liver disease

Non-alcoholic fatty liver disease is one of the major causes of chronic liver injury and is associated with metabolic risk factors including obesity, type 2 diabetes mellitus, dyslipidaemia, and hypertension. NAFLD includes a wide range of clinical conditions from simple steatosis to nonalcoholic steatohepatitis, advanced fibrosis, and liver cirrhosis. This disease has been associated not only with increased liver-related mortality but more importantly with increased cardiovascular and cancer mortality. In many patients NAFLD can be diagnosed with the evidence of hepatic steatosis on ultrasonography and lack of secondary causes of hepatic fat accumulation (alcoholic steatosis, medications, or hereditary disorders). Liver biopsy remains the gold standard for the diagnosis of NASH and the evaluation of the severity of liver fibrosis. This technique has several disadvantages in relation to its routine and repeated use. Many biomarkers have been proposed in order to estimate the degree of liver fibrosis in NASH patients noninvasively, such as the APRI, FIB-4, NFS, and BARD. Treatment of NAFLD should include: weight loss, physical activity, several pharmacologic agents to improve insulin resistance, lipid-lowering agents, and inhibition of progression of fibrosis. A multi-disciplinary team of experts may be needed to effectively treat patients with NAFLD.