Non-Alcoholic Fatty Liver Disease

Non-alcoholic fatty liver disease (NAFLD) is recognized as the hepatic manifestation of metabolic syndrome and is the most common chronic liver disease in Western countries. NAFLD encompasses a spectrum of conditions ranging from simple hepatic steatosis to non-alcoholic steatohepatitis (NASH) defined histologically by hepatic steatosis, ballooned hepatocytes, Mallory-Denk bodies and variable degrees of fibrosis on liver biopsy. Whereas simple steatosis carries a benign course, individuals with NASH can progress to cirrhosis and hepatocellular carcinoma. Obesity and metabolic syndrome are major risk factors for NASH. There are currently no approved pharmacologic therapies for NASH. Management includes lifestyle modification (weight loss, diet, exercise) and optimizing control of underlying comorbid features of metabolic syndrome (diabetes, hypertension, dyslipidemia). Patients with NASH and cirrhosis are at risk for hepatocellular carcinoma (HCC) and should be followed with imaging for HCC surveillance.