Abstract

Nonalcoholic fatty liver disease (NAFLD) and its progression state; nonalcoholic steatohepatitis (NASH) affect more than 15% and 5%, respectively, of the US population. The workup of patients with suspected NAFLD consists in excluding competing etiologies and systemic evaluation of metabolic comorbidities. NAFLD is histologically categorized into steatosis and steatohepatitis, two states with fairly dichotomous natural history. While significant progress has been made in terms of noninvasive prediction of advanced fibrosis, insufficient progress has been made in steatohepatitis prediction. Currently, liver biopsy remains the gold standard for the histological stratification of NAFLD. While sustained weight loss can be effective to treat nonalcoholic steatohepatitis (NASH), it is often difficult to achieve. Insulin sensitizers and hypolipemiants can ameliorate nonalcoholic steatohepatitis. Gradual weight loss, diet management and physical activity are other important treatment components of this condition. Foregut bariatric surgery can be quite effective in improving hepatic histology in selected patients without liver failure or significant portal hypertension. Thiazolidinediones have shown promise and the results from the ongoing, large multicenter study should become available soon. Finally, several recent studies have highlighted that cardiovascular disease is the single most important cause of morbidity and mortality in this patient population.