Review article: diagnosis and treatment of non‐alcoholic fatty liver disease

Abstract

SUMMARY BackgroundNon-alcoholic fatty liver disease (NAFLD) is an increasingly prevalent condition affecting adults and children, leading to significant morbidity. It is often associated with the metabolic syndrome, although multiple pathogenetic mechanisms have been suggested. In the coming decades, it promises to be the leading cause of liver disease in industrial countries. AimTo provide a comprehensive, updated review of diagnosis and management of NAFLD and to appraise the evolution of new modalities in these areas. MethodsAn Ovid MEDLINE search was performed to identify pertinent original research and review articles. Selected references in these articles were also evaluated. Results The diagnosis of hepatic steatosis and steatohepatitis or non-alcoholic steatohepatitis (NASH)is not yet possible without liver biopsy. This is impractical given the large numbers affected by the condition. Current therapy has focused on improving insulin resistance and mediators of inflammation, factors probably associated with disease progression. ConclusionsThere are no proven non-invasive diagnostic modalities to distinguish NAFLD and NASH, but new biomarker panels are approximating the liver biopsy in accuracy. Therapeutic targets of drug development are in early stages, but a multifaceted approach will probably yield several treatment options in the years to come.

Nonalcoholic fatty liver disease: a challenge for pediatricians

“…It could prevent unnecessary liver biopsy. 7 Histopathology of NAFLD in an adult is defined in the classical way. The largest biopsy series of pediatric NAFLD represents two distinct injury patterns compatible with steatohepatitis.…”

“…5,6 However, the true prevalence of NAFLD and NASH is unknown given that the disease's definition and modalities used for diagnosis are not standardized. 7 Most studies of the prevalence of fatty liver in children have been restricted to the use of indirect measures, such as blood tests or ultrasound, to predict a histological outcome. 8 Table 1 shows some epidemiological study results.…”

“…However, these studies could not contradict race-based selection bias. [5][6][7]9,17 Prevalence of obesity and its related comorbidity, especially NAFLD, has been increased notably in last decades. Epidemiological studies are the fundamental part of research for diagnosis and management of such a chronic disease because of profound decrease in the quality of life.…”

Burning hepatic fat: Therapeutic potential for liver-specific thyromimetics in the treatment of nonalcoholic fatty liver disease

“…7,13 Several other agents, such as antioxidants, hepatoprotective compounds, and drugs to induce weight reduction, have been evaluated and have shown inconclusive or no effects. 12 In this issue of HEPATOLOGY, Cable and co-workers 14 conducted an interesting animal study assessing the effects of liver-selective thyroid hormone receptor (TR) agonists on liver steatosis in rodents. Before getting into details of their work, a word about the so-called thyromimetic compounds 15,16 is in order.…”

“…10 Therapeutic interventions in NAFLD are mainly based on lifestyle changes, including diet and exercise. 11,12 Currently, there are no approved pharmacological therapies for NAFLD, but because insulin resistance is almost universally present in patients with this condition, drugs that increase insulin sensitivity are currently undergoing extensive evaluation and hold promise as therapeutically effective agents. 7,13 Several other agents, such as antioxidants, hepatoprotective compounds, and drugs to induce weight reduction, have been evaluated and have shown inconclusive or no effects.…”