Non‐Alcoholic Fatty Liver Disease

Non-alcoholic fatty liver disease (NAFLD) is currently recognized as common problem across the globe. NAFLD encompass a wide spectrum of liver damage, ranging from simple steatosis to non-alcoholic steatohepatitis (NASH), advanced fibrosis, and cirrhosis. NAFLD is not only associated with insulin resistance but also associated with an increase in incidence of cardiovascular disease (CVD). Importantly. NAFLD is also regarded as the hepatic component of the metabolic syndrome. Currently, the “gold standard” for the diagnosis of NASH is liver biopsy. Therefore, the exact prevalence of NAFLD is uncertain because of the absence of simple non-invasive diagnostic tests to facilitate an estimate of prevalence. However, in people with type 2 diabetes the prevalence of NAFLD, defined by ultrasound, may be as high as 70%. Limited data suggest that the prevalence of NASH could be as high as 11% in the general population suggesting there is a worsening future public health problem in this field of medicine. With a burgeoning epidemic of diabetes in an ageing population, it is likely that the prevalence of NASH will continue to increase over time as both factors are important risk factors for liver fibrosis. NASH is an important subgroup within the spectrum of NAFLD that progresses over time with worsening fibrosis and cirrhosis. It is, therefore, important to understand the pathogenesis of NASH in particular, to develop strategies for interventions to treat this condition. Currently, weight loss and hypocaloric diet are advocated as a therapeutic lifestyle option. In addition to that described above this chapter will also discuss the emerging association of NAFLD with CVD and the sleep apnea syndrome. The factors that accelerate progression of NAFLD to NASH in addition to potential therapeutic agents are also discussed.