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Non-alcoholic Fatty Liver Disease

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Liver Disease in Clinical Practice

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Abstract

Non-alcoholic fatty liver disease (NAFLD) is a chronic liver disease closely associated with features of the metabolic syndrome. NAFLD represents the most common aetiology of liver disease globally and encompasses a histopathological spectrum of disease ranging from simple steatosis to inflammation with hepatocyte injury, and eventually to fibrosis and cirrhosis. Obesity and insulin resistance lead to hepatic steatosis through increased free fatty acid delivery from adipose tissue, decreased hepatic fatty acid clearance and enhanced de novo lipogenesis. Disease progression from steatosis to inflammation and fibrosis is variable and likely occurs through complex interplay of genetic, environmental and gut microbial factors. The evolution of fibrosis is an essential prognostic characteristic in NAFLD and represents the only histological feature to predict overall mortality, liver transplantation and liver-related events. Therefore, risk stratification for fibrosis is crucial to identify patients with advanced disease using non-invasive approaches such as transient elastography or validated scoring systems, combined in two-tiered risk assessment pathways. Management of NAFLD comprises a multidisciplinary framework with emphasis on reducing cardiovascular risk as well as improving liver-related morbidity and mortality through lifestyle adaptation and pharmacological intervention. While targeted, liver-specific pharmacotherapy for NAFLD remains deficient at present, multiple agents have shown promise and are undergoing late-stage development to supplement standard care in progressive NAFLD.

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Correspondence to Jeremy Cobbold .

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Koeckerling, D., Marjot, T., Cobbold, J. (2022). Non-alcoholic Fatty Liver Disease. In: Cross, T. (eds) Liver Disease in Clinical Practice. In Clinical Practice. Springer, Cham. https://doi.org/10.1007/978-3-031-10012-3_7

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  • DOI: https://doi.org/10.1007/978-3-031-10012-3_7

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-10011-6

  • Online ISBN: 978-3-031-10012-3

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