Review article: current management of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis.
BACKGROUND
Non-alcoholic fatty liver disease (NAFLD) is the hepatic manifestation of metabolic syndrome.


OBJECTIVE
To assess the epidemiological impact and the current management of patients with NAFLD.


METHODS
Published peer-reviewed literature and abstracts concerning NAFLD and non-alcoholic steatohepatitis (NASH) were reviewed. Articles specifically related to epidemiology, diagnosis and current treatment strategies for NAFLD and NASH are summarized.


RESULTS
NAFLD is strongly associated with the epidemic of obesity and type-2 diabetes mellitus, and is estimated to affect about 20-30% of the population in the US. From the spectrum of NAFLD, only patients with biopsy-proven NASH (estimated prevalence in the US population is about 3-5%) have been convincingly shown to progress to cirrhosis, liver failure and hepatocellular carcinoma. The clinical manifestation of NAFLD is usually absent or subtle, with abnormal aminotransferases or incidental radiographic findings of fatty liver. The pathogenesis of NAFLD is attributed to a multi-hit process involving insulin resistance, oxidative stress, apoptotic pathways, and adipocytokines. In 2008, there is no established treatment for NAFLD. Weight loss and treatment for each component of metabolic syndrome. Nevertheless, a large number of agents are being considered in clinical trials of patients with NASH.


CONCLUSIONS
Awareness of the tremendous impact of NAFLD as an important cause of chronic liver disease is increasing along with a great deal of information about its pathogenesis. Future, well-designed clinical trials that target specific pathways involved in the pathogenesis of NASH are urgently needed.
Younossi
Z M
ZM
Center for Liver Diseases, Inova Fairfax Hospital, Falls Church, VA, USA. Zobair.younossi@inova.org
D000975:Antioxidants / Q000627:therapeutic use; D003924:Diabetes Mellitus, Type 2 / Q000209:etiology; D005234:Fatty Liver / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology*; D005260:Female; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D007333:Insulin Resistance; D008297:Male; D009765:Obesity / Q000150:complications; D018384:Oxidative Stress; D012307:Risk Factors; D014580:Ursodeoxycholic Acid / Q000627:therapeutic use; D015431:Weight Loss / Q000187:drug effects
D000975:Antioxidants; D000960:Hypolipidemic Agents; D014580:Ursodeoxycholic Acid