-Nonalcoholic fatty liver disease (NAFLD) refers to the presence of hepatic steatosis in the absence of significant alcohol consumption.
-NAFLD is subdivided into nonalcoholic fatty liver (NAFL) and nonalcoholic steatohepatitis (NASH)
-NAFLD is commonly associated with the metabolic syndrome, obesity, type 2 diabetes, and dyslipidemia
-80% of patients with the metabolic syndrome have NAFLD.
-In obese patients, the risk of NAFLD elevated fivefold.
-Prevalence is highest in Hispanics and lowest in blacks.
-Women are affected more frequently than men.
Symptoms & Signs: Often asymptomatic; but may present with fatigue, malaise, right upper quadrant discomfort; Hepatomegaly
Diagnosis: Elevated serum aminotransferase levels, hepatomegaly, and/or steatosis.
Imaging studies: Ultrasound, CT, MRI; increased echogenicity on ultrasound, decreased hepatic attenuation on computed tomography, or an increased fat signal on magnetic resonance imaging
Liver biopsy: Steatosis with hepatocyte ballooning; lobular or portal inflammation
Lifestyle changes: Diet, exercise; refraining from alcohol
Pharmacologic weight reduction: Orlistat, topiramate, phentermine
Pharmacologic therapy: Metformin to improve hepatic insulin sensitivity; vaccination for hepatitis A virus and hepatitis B virus; lipid-lowering therapy if there is hyperlipidemia
Antioxidants: Vitamin E
Persons with NAFLD are at increased risk for cardiovascular disease, chronic kidney disease, and colorectal cancer; Some will progress to cirrhosis
Q: What is the most important risk factor for the development of NAFLD? Insulin resistance
Q: What is the most common liver disease in industrialized Western countries? NAFLD