Source Division of Gastroenterology, Department of Medicine, Walter Reed National Military Medical Center, Washington, D.C.
As the global incidence of obesity has increased, nonalcoholic fatty liver disease (NAFLD) has become a worldwide health concern. NAFLD occurs in children and adults of all ethnicities, and includes isolated fatty liver and nonalcoholic steatohepatitis (NASH). Patients with NASH are at risk for developing cirrhosis, hepatic decompensation, and hepatocellular carcinoma (HCC) and have increased all-cause mortality. NAFLD is associated with a variety of clinical conditions and is an independent risk factor for HCC. The pathogenesis of NAFLD and the specific steps that lead to NASH and advanced fibrosis are not fully understood, although researchers have found that a combination of environmental, genetic, and metabolic factors lead to advanced disease. There have been improvements in non-invasive radiographic methods to diagnose NAFLD-especially for advanced disease. However liver biopsy is still the standard method of diagnosis for NASH. There are many challenges to treating patients with NASH, and no therapies have been approved by the US Food and Drug Administration; multi-modal approaches are being developed and becoming the standard of care. We review pathogenesis and treatment approaches for the West's largest liver-related public health concern.