title: Epidemiology and natural history of non-alcoholic fatty liver disease.
abstract: Non-alcoholic steatohepatitis (NASH) is part of the spectrum of non-alcoholic fatty liver disease (NAFLD) that leads to progressive liver disease and presents a growing challenge to public health. Because of the increased prevalence of metabolic syndrome and obesity, NAFLD and NASH have expanded to a substantial extent. In NASH patients, advanced fibrosis is the major predictor of morbidity and liver-related mortality, and an accurate diagnosis of NASH is mandatory. Although there is currently no validated test of serum biomarkers available to diagnose NASH, and histologic evaluation with a liver biopsy remains the gold standard, screening for fibrosis is recommended in patients with suspicion of NASH. Clinical prediction models and serum biomarkers for advanced fibrosis have relatively good negative predictive value and can be useful for screening. Also, transient elastography is increasingly available to estimate fibrosis in NASH. Therefore, due to the lack of a reliable and accepted non-invasive diagnostic modality, screening for NASH in the general population is not currently recommended. Better understanding of the natural history of NASH is needed to evaluate the utility and cost-effectiveness of screening.
authors.affiliation: Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA.
authors.forename: Yousef
authors.initials: Y
authors.lastname: Fazel
authors.affiliation: Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA.
authors.forename: Aaron B
authors.initials: AB
authors.lastname: Koenig
authors.affiliation: Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Sayiner
authors.affiliation: Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA; Center for Liver Diseases Department of Medicine, Inova Fairfax Hospital, Falls Church, VA, USA.
authors.forename: Zachary D
authors.initials: ZD
authors.lastname: Goodman
authors.affiliation: Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA; Center for Liver Diseases Department of Medicine, Inova Fairfax Hospital, Falls Church, VA, USA. Electronic address: zobair.younossi@inova.org.
authors.forename: Zobair M
authors.initials: ZM
authors.lastname: Younossi
mesh_terms: D018450:Disease Progression; D054459:Elasticity Imaging Techniques; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging / Q000473:pathology*; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000473:pathology; D065626:Non-alcoholic Fatty Liver Disease / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000473:pathology; D015995:Prevalence
keywords: Epidemiology; Fibrosis; NAFLD; NASH; Screening