Review article: diagnosis and treatment of non-alcoholic fatty liver disease.
BACKGROUND
Non-alcoholic fatty liver disease (NAFLD) is an increasingly prevalent condition affecting adults and children, leading to significant morbidity. It is often associated with the metabolic syndrome, although multiple pathogenetic mechanisms have been suggested. In the coming decades, it promises to be the leading cause of liver disease in industrial countries.


OBJECTIVE
To provide a comprehensive, updated review of diagnosis and management of NAFLD and to appraise the evolution of new modalities in these areas.


METHODS
An Ovid MEDLINE search was performed to identify pertinent original research and review articles. Selected references in these articles were also evaluated.


RESULTS
The diagnosis of hepatic steatosis and steatohepatitis or non-alcoholic steatohepatitis (NASH) is not yet possible without liver biopsy. This is impractical given the large numbers affected by the condition. Current therapy has focused on improving insulin resistance and mediators of inflammation, factors probably associated with disease progression.


CONCLUSIONS
There are no proven non-invasive diagnostic modalities to distinguish NAFLD and NASH, but new biomarker panels are approximating the liver biopsy in accuracy. Therapeutic targets of drug development are in early stages, but a multifaceted approach will probably yield several treatment options in the years to come.
Cedars Sinai Medical Center, Los Angeles, CA, USA.
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D000328:Adult; D000368:Aged; D001219:Aspartate Aminotransferases / Q000378:metabolism*; D005234:Fatty Liver / Q000175:diagnosis* / Q000628:therapy; D005260:Female; D006801:Humans; D007333:Insulin Resistance / Q000502:physiology; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000209:etiology; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D018384:Oxidative Stress / Q000502:physiology; D015854:Up-Regulation / Q000502:physiology
D001219:Aspartate Aminotransferases