Hepatic Steatosis and Non‐Alcoholic Fatty Liver Disease

Nonalcoholic fatty liver disease (NALFD) encompasses a wide spectrum of liver injury ranging from bland hepatic steatosis to nonalcoholic steatohepatitis (NASH). Bland steatosis follows a relatively benign clinical course, but NASH may progress to cirrhosis. NAFLD affects about one third of the adult US population and up to 10% of children and teenagers. The demographics of NAFLD in the general population mirrors that of the metabolic syndrome, which is characterized by obesity, diabetes, hypertension, and dyslipidemia. The real prevalence of NASH in the general population remains unknown, but up to 15% of patients with NASH on liver biopsy may progress to cirrhosis within 15 years. Several clinical and laboratory markers of liver injury can be used to predict the severity of NAFLD and help in deciding the need for a liver biopsy. Pharmacological therapy holds promise, but life-style intervention with diet and increased physical activity remains the only treatment recommendation.