Non-alcoholic fatty liver disease

Non-alcoholic fatty liver disease (NAFLD) is a global health problem, with an estimated prevalence of 30% among adults in industrialized countries, associated with obesity and type 2 diabetes mellitus. NAFLD is defined histologically and represents a spectrum from simple steatosis to steatohepatitis, fibrosis and cirrhosis. Hepatic triglyceride droplet accumulation is considered the first feature in the natural history, which in some patients is associated with inflammation and fibrosis, through the interaction of environmental and host factors. Patients with NAFLD are generally asymptomatic and usually present with incidental findings of abnormal liver function tests or an echo-bright liver on ultrasound. A firm diagnosis is required for effective clinical management, and biopsy is frequently needed to assess disease severity. Non-invasive tests are increasingly used in clinical practice to stratify risk and prioritize liver biopsy appropriately. Treatment is focused on weight reduction through dietary modifications and exercise. Cardiovascular risk factors should be addressed and the treatment of diabetes, hypertension and hyperlipidaemia optimized. Liver-specific treatments such as vitamin E and pioglitazone have shown benefit in clinical trials, but concerns remain regarding their long-term safety. Obeticholic acid has demonstrated promise.