Nonalcoholic fatty liver disease

-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

Treatment:

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

Bariatric surgery

Prognosis:

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

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