Metabolic Syndrome and Non‐alcoholic Fatty Liver Disease

Non-alcoholic fatty liver disease (NALFD) encompasses a wide spectrum of liver injury, ranging from bland hepatic steatosis to non-alcoholic 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 adolescents and preadolescents. The demographics of NAFLD in the general population mirror those 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 decide the need for a liver biopsy. Pharmacologic therapy holds promise, but lifestyle intervention with diet and increased physical activity remain the only treatment recommendation.