Nonalcoholic fatty liver disease (NAFLD) is an important cause of morbidity and mortality worldwide and is rapidly becoming the leading cause of end-stage liver disease and liver transplant. With a prevalence of 30% in the United States, it has reached epidemic proportions. The clinical syndrome of NAFLD spans from bland steatosis to steatohepatitis, which can progress to fibrosis and cirrhosis. The pathogenesis includes the roles of hormones, nutritional and intestinal dysbiosis, insulin resistance, lipotoxicity, hepatic inflammation, and genes. Noninvasive testing and liver biopsy indications are reviewed. Approved and investigational therapies for NAFLD and nonalcoholic steatohepatitis are outlined in this article.
Key points
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Nonalcoholic fatty liver disease (NAFLD) is a systemic disease.
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NAFLD pathogenesis involves hormonal, nutritional, and genetic factors.
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NAFLD mortality is caused by cardiovascular disease, cancer, and hepatic disease.
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Patients with NAFLD should be risk stratified at diagnosis and longitudinally for the presence and degree of fibrosis, and referred if advanced disease is suspected.
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The cornerstone of NAFLD management is 7% to 9% weight loss and management of cardiovascular, oncologic, and hepatic risk factors.
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