Non-alcoholic fatty liver disease
Non-alcoholic fatty liver disease (NAFLD) is now the most common cause of liver disease in the developed world. It is largely caused by obesity and describes a spectrum of disease ranging from:
NAFLD is thought to represent the hepatic manifestation of the metabolic syndrome and hence insulin resistance is thought to be the key mechanism leading to steatosis
Non-alcoholic steatohepatitis (NASH) is a term used to describe liver changes similar to those seen in alcoholic hepatitis in the absence of a history of alcohol abuse. It is relatively common and thought to affect around 3-4% of the general population. The progression of disease in patients with NASH may be responsible for a proportion of patients previously labelled as cryptogenic cirrhosis
Features
Management
- steatosis - fat in the liver
- steatohepatitis - fat with inflammation, non-alcoholic steatohepatitis (NASH), see below
- progressive disease may cause fibrosis and liver cirrhosis
NAFLD is thought to represent the hepatic manifestation of the metabolic syndrome and hence insulin resistance is thought to be the key mechanism leading to steatosis
Non-alcoholic steatohepatitis (NASH) is a term used to describe liver changes similar to those seen in alcoholic hepatitis in the absence of a history of alcohol abuse. It is relatively common and thought to affect around 3-4% of the general population. The progression of disease in patients with NASH may be responsible for a proportion of patients previously labelled as cryptogenic cirrhosis
Associated factors
- obesity
- hyperlipidaemia
- type 2 diabetes mellitus
- jejunoileal bypass
- sudden weight loss/starvation
Features
- usually asymptomatic
- hepatomegaly
- ALT is typically greater than AST
- increased echogenicity on ultrasound
Management
- the mainstay of treatment is lifestyle changes (particularly weight loss) and monitoring
- there is ongoing research into the role of gastric banding and insulin-sensitising drugs (e.g. Metformin)