Nonalcoholic fatty liver disease (NAFLD) is the most common chronic hepatic disorder in Western countries, with a prevalence of 20–30%. NAFLD comprises ‘silent liver disease’, in which simple steatosis is the only histological finding and which is benign in course, and nonalcoholic steatohepatitis, which is characterized by hepatocellular injury and inflammation with or without fibrosis. NAFLD is clinically important, because even benign fatty liver can progress to steatohepatitis in many patients, which can lead to liver cirrhosis and its complications and hepatocellular carcinoma. NAFLD is a hepatic manifestation of metabolic syndrome; it is closely related to other clinical features of metabolic syndrome, and thus to cardiovascular morbidity. There are several different noninvasive techniques for formal diagnosis and follow-up, but liver biopsy remains the gold standard. The most important therapeutic strategies include lifestyle changes, including changes in dietary habits aimed at weight loss and blood pressure regulation, with a consequent decrease in insulin resistance. For some patients with NAFLD/nonalcoholic steatohepatitis, pharmacological treatment is the best option, although further studies are needed to confirm its efficacy and tolerability.

1.
Vernon G, Baranova A, Younossi ZM: Systematic review: the epidemiology and natural history of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in adults. Aliment Pharmacol Ther 2011;34:274–285.
2.
Vanni E, Bugianesi E, Kotronen A, De Minicis S, Jarvinen HY, Svegliati-Baroni G: From the metabolic syndrome to NAFLD or vice versa. Dig Liver Dis 2010;42:320–330.
3.
Bedogni G, Miglioli L, Masutti F, Tiribelli C, Marchesini G, Bellentani S: Prevalence of and risk factors for nonalcoholic fatty liver disease: the Dionysos nutrition and liver study. Hepatology 2005;42:44–52.
4.
Bellentani S, Scaglioni F, Marino M, Bedogni G: Epidemiology of non-alcoholic fatty liver disease. Dig Dis 2010;28:155–161.
5.
Ekstedt M, Franzen LE, Mathiesen UL, et al: Long-term follow-up of patients with NAFLD and elevated liver enzymes. Hepatology 2006;44:865–873.
6.
Petta S, Muratore C, Craxi A: Non-alcoholic fatty liver disease pathogenesis: the present and the future. Dig Liver Dis 2009;41:615–625.
7.
Pinzani M: Pathophysiology of non-alcoholic steatohepatitis and basis for treatment. Dig Dis 2011;29:243–248.
8.
Powell E, Jonsson R, Clouston AD: Metabolic factors and non-alcoholic fatty liver disease as co-factors in other liver diseases. Dig Dis 2010;28:186–191.
9.
Cheung O, Sanyal AR: Recent advances in nonalcoholic fatty liver disease. Curr Opin Gastroenterol 2010;26:202–208.
10.
Bugianesi E, McCullough AJ, Marchesini G: Insulin resistance: a metabolic pathway to chronic liver disease. Hepatology 2005;42:987–1000.
11.
Day CP, James OF: Steatohepatitis: a tale of ‘two hits’. Gastroenterology 1998;114:842–845.
12.
Dowman JK, Tomlinson JW, Newsome PN: Systematic review: the diagnosis and staging of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis. Aliment Pharmacol Ther 2011;33:525–540.
13.
Ratziu V, Bellentani S, Cortez-Pinto H, Day C, Marchesini G: A position statement on NAFLD/NASH based on the EASL 2009 special conference. J Hepatol 2010;52:372–384.
14.
Gaia S, Carenzi S, Barilli A, et al: Reliability of transient elastography for the detection of fibrosis in non-alcoholic fatty liver disease and chronic viral hepatitis. J Hepatol 2011;54:64–71.
15.
Satapathy SK, Sanyal AJ: Novel treatment modalities for nonalcoholic steatohepatitis. Trends Endocrinol Metab 2010;21:668–675.
16.
Moore BJ: Symposium 1: overnutrition. Consequences and solutions – non-alcoholic fatty liver disease: the hepatic consequences of obesity and the metabolic syndrome. Proc Nutr Soc 2010;69:211–220.
17.
Ratziu V, Charlotte F, Bernhardt C, et al: Long-term efficacy of rosiglitazone in nonalcoholic steatohepatitis: results of the fatty liver improvement by rosiglitazone therapy (FLIRT 2) extension trial. Hepatology 2010;51:445–453.
18.
Ratziu V, De Ledinghen V, Oberti F, et al: A randomized controlled trial of high-dose ursodeoxycholic acid for nonalcoholic steatohepatitis. J Hepatol 2011;54:1011–1019.
19.
Sanyal AJ, Chalasani N, Kowdley KV, et al: Pioglitazone, vitamin E or placebo for nonalcoholic steatohepatitis. N Engl J Med 2010;18:1675–1685.
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