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Evaluation and management of obesity-related nonalcoholic fatty liver disease

Nature Clinical Practice Gastroenterology & Hepatology volume 4, pages 432–441 (2007)Cite this article

Abstract

The clinicopathologic spectrum of nonalcoholic fatty liver disease (NAFLD) ranges from simple steatosis to nonalcoholic steatohepatitis (NASH). Simple steatosis has a relatively benign clinical course, but NASH can progress to cirrhosis and hepatocellular carcinoma. NAFLD occurs in the absence of significant alcohol use and is considered to be the hepatic manifestation of metabolic syndrome. NAFLD affects approximately 30% of the US population and the incidence seems to be rising as the obesity epidemic continues. At present, the most accurate modality for the diagnosis of NASH is liver biopsy; however, many patients do not have a liver biopsy, and in the absence of more-accurate imaging technologies and serum markers, the diagnosis is frequently one of exclusion. As yet there is no convincingly effective treatment for NAFLD—a multimodal treatment plan that targets obesity, insulin resistance, hyperlipidemia and hypertension might be the best option for these patients.

Key Points

  • Nonalcoholic fatty liver disease (NAFLD) is considered to be the hepatic manifestation of metabolic syndrome

  • Approximately 30% of the US population have NAFLD and its incidence seems to be rising as the obesity epidemic continues

  • The NAFLD spectrum ranges from relatively benign simple steatosis to nonalcoholic steatohepatitis, which can progress to cirrhosis

  • At present, the most accurate modality for the diagnosis of nonalcoholic steatohepatitis is liver biopsy; however, liver biopsy is not performed in a significant number of cases and in the absence of more-accurate imaging technologies and serum markers, the diagnosis is frequently one of exclusion

  • There is currently no proven effective treatment for NAFLD; however, a multimodal treatment plan that targets obesity, insulin resistance, hyperlipidemia and hypertension might be the best option

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Acknowledgements

Charles P Vega, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the Medscape-accredited continuing medical education activity associated with this article.

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  1. C Nugent is a Research Project Associate at Inova Fairfax Hospital Annandale, VA, USA.,

    Clare Nugent

  2. ZM Younossi is Executive Director of Research for Inova Health System, Executive Director of the Center for Liver Diseases at Inova Fairfax Hospital, Professor of Medicine, Virginia Commonwealth University, Inova Campus, and Affiliate Professor of Biomedical Sciences at George Mason University.,

    Zobair M Younossi

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Correspondence to Zobair M Younossi.

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Zobair Younossi has received grant/research support from Axcan, Idenix, Roche and Vertex. Clare Nugent declared no competing interests.

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Nugent, C., Younossi, Z. Evaluation and management of obesity-related nonalcoholic fatty liver disease. Nat Rev Gastroenterol Hepatol 4, 432–441 (2007). https://doi.org/10.1038/ncpgasthep0879

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