Should nonalcoholic fatty liver disease be renamed?
BACKGROUND
None of the synonyms of nonalcoholic fatty liver disease (NAFLD) include clinical correlates nor do they mention insulin resistance, a recognized determinant of the etiopathogenesis and natural history of NAFLD.


METHODS
The literature concerning the pathogenesis and definition of NAFLD is reviewed.


RESULTS
The reasons why NAFLD should be renamed are: (a) clinically meaningful hepatic steatosis could be present at less than 5% triglyceride hepatic content; (b) steatosis is usually no longer observed in the most advanced forms of NAFLD ('cryptogenic cirrhosis'); (c) the concurrence of metabolic derangements could be more important than alcohol in the pathogenesis of alcoholic liver disease; (d) a concurrent metabolic etiology might worsen the course of chronic HCV and autoimmune hepatitis; (e) in NAFLD the liver is a target organ of the metabolic syndrome, a systemic subclinical inflammatory state.


CONCLUSIONS
The introduction of a positive criterion also mentioned in its definition would benefit the diagnosis of NAFLD and of steatohepatitis observed in the setting of other liver diseases, help to estimate the risk of its progression and aid the treatment of metabolic (fatty) liver disorders. There is a compelling need for an experts' agreement on a new definition of insulin resistance/metabolic-related liver disease.
Loria
Paola
P
Dipartimento di Medicina Interna Università di Modena e Reggio Emilia, Modena, Italy. loria.paola@unimore.it
Lonardo
Amedeo
A
Carulli
Nicola
N
D002908:Chronic Disease; D003937:Diagnosis, Differential; D018450:Disease Progression; D005234:Fatty Liver / Q000145:classification* / Q000503:physiopathology*; D006801:Humans; D007333:Insulin Resistance; D020738:Leptin / Q000378:metabolism; D012307:Risk Factors; D009626:Terminology as Topic
D020738:Leptin