Metabolic correlation and management strategies of non-alcoholic fatty liver disease: An Asian Indian perspective

SummaryPreviously believed to be innocuous, non-alcoholic fatty liver (NAFLD) is now known to progress to non-alcoholic steatohepatitis (NASH), hepatic fibrosis and even cirrhosis. NAFLD has emerged as an integral component of the metabolic syndrome, with insulin resistance as the central pathogenic feature. Evidence now suggests that NAFLD is independently correlated to insulin resistance regardless of adiposity. Since, insulin resistance and the metabolic syndrome are widely prevalent in Asian Indians, it is reasonable to presume that NAFLD would also be prevalent, however, data are scarce. Some recent data indicate that hepatic fat content of Asian Indians is almost twice in amount for similar body mass index when compared to white Caucasians. It is important to manage insulin resistance and the metabolic syndrome which underlie NAFLD and NASH. Treatment with insulin sensitizers and some other drugs have shown improvement in hepatic aminotransferase levels and even hepatic histology, but more definite evidence is required for firm recommendation for drug therapy of NAFLD and NASH.