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Natural history and management of nonalcoholic fatty liver disease in adults

Authors
Sunil G Sheth, MD
Sanjiv Chopra, MD, MACP
Section Editor
Keith D Lindor, MD
Deputy Editor
Anne C Travis, MD, MSc, FACG, AGAF

INTRODUCTION

Nonalcoholic fatty liver disease (NAFLD) refers to the presence of hepatic steatosis when no other causes for secondary hepatic fat accumulation (eg, heavy alcohol consumption) are present. NAFLD may progress to cirrhosis and is likely an important cause of cryptogenic cirrhosis [1-4].

This topic will review the natural history and treatment of NAFLD. The pathogenesis, clinical manifestations, and diagnosis of NAFLD are discussed separately. (See "Epidemiology, clinical features, and diagnosis of nonalcoholic fatty liver disease in adults".)

DEFINITIONS

NAFL versus NASH — Nonalcoholic fatty liver disease (NAFLD) is subdivided into nonalcoholic fatty liver (NAFL) and nonalcoholic steatohepatitis (NASH). In NAFL, hepatic steatosis is present without evidence of inflammation, whereas in NASH, hepatic steatosis is associated with hepatic inflammation that histologically is indistinguishable from alcoholic steatohepatitis [5,6]. Other terms that have been used to describe NASH include pseudoalcoholic hepatitis, alcohol-like hepatitis, fatty liver hepatitis, steatonecrosis, and diabetic hepatitis.

NAFLD activity score — One way of differentiating NAFL from NASH is to obtain a liver biopsy and calculate the NAFLD activity score (NAS) [7]. The NAS is the sum of the biopsy's individual scores for steatosis (0 to 3), lobular inflammation (0 to 2), hepatocellular ballooning (0 to 2), and fibrosis (0 to 4) [7]. An NAS <3 corresponds to NAFL, 3 to 4 corresponds to borderline NASH, and a score ≥5 corresponds to NASH. (See "Histologic scoring systems for chronic liver disease", section on 'Nonalcoholic fatty liver disease'.)

NATURAL HISTORY

Patients with nonalcoholic fatty liver disease (NAFLD) may eventually develop cirrhosis. Cirrhosis develops when simple steatosis progresses to steatohepatitis and then fibrosis. Among patients with cryptogenic cirrhosis, up to 70 percent have risk factors for NAFLD [1,4]. While the risk of disease progression among patients with NAFLD has been evaluated in multiple studies, the results have been variable, and the risk of developing advanced fibrosis among patients with NAFLD is unclear [3,4,8-19]. A meta-analysis that included 11 studies looked at fibrosis progression in 366 patients with NAFLD [20]. Overall, fibrosis progressed in 132 (36 percent), remained stable in 158 (46 percent), and improved in 76 (21 percent). It appears that patients with simple steatosis on biopsy are at low risk for developing significant fibrosis, whereas those with nonalcoholic steatohepatitis are at higher risk [21]. In addition, some patients with fibrosis show regression of their disease [8-10].

                             

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Literature review current through: Nov 2016. | This topic last updated: Tue Nov 08 00:00:00 GMT+00:00 2016.
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