Review Article: Current Management of NAFLD and NASH
Review Article: Current Management of NAFLD and NASH
Background: Non-alcoholic fatty liver disease (NAFLD) is the hepatic manifestation of metabolic syndrome.
Aim: To assess the epidemiological impact and the current management of patients with NAFLD.
Methods: Published peer-reviewed literature and abstracts concerning NAFLD and non-alcoholic steatohepatitis (NASH) were reviewed. Articles specifically related to epidemiology, diagnosis and current treatment strategies for NAFLD and NASH are summarized.
Results: NAFLD is strongly associated with the epidemic of obesity and type-2 diabetes mellitus, and is estimated to affect about 20-30% of the population in the US. From the spectrum of NAFLD, only patients with biopsy-proven NASH (estimated prevalence in the US population is about 3-5%) have been convincingly shown to progress to cirrhosis, liver failure and hepatocellular carcinoma. The clinical manifestation of NAFLD is usually absent or subtle, with abnormal aminotransferases or incidental radiographic findings of fatty liver. The pathogenesis of NAFLD is attributed to a multi-hit process involving insulin resistance, oxidative stress, apoptotic pathways, and adipocytokines. In 2008, there is no established treatment for NAFLD. Weight loss and treatment for each component of metabolic syndrome. Nevertheless, a large number of agents are being considered in clinical trials of patients with NASH.
Conclusions: Awareness of the tremendous impact of NAFLD as an important cause of chronic liver disease is increasing along with a great deal of information about its pathogenesis. Future, well-designed clinical trials that target specific pathways involved in the pathogenesis of NASH are urgently needed.
Non-alcoholic steatohepatitis (NASH) was first described more than two decades ago and is now considered part of a spectrum of non-alcoholic fatty liver diseases (NAFLD). NASH resembles alcoholic steatohepatitis (ASH), but occurs in individuals who do not consume excessive amounts of alcohol. Both the more encompassing NAFLD and its progressive subtype, NASH, are considered to be the hepatic manifestation of metabolic syndrome.
Non-alcoholic fatty liver disease is the most common cause of chronic liver disease in the US. The estimated prevalence of NAFLD is 20-30% and for NASH it is estimated at 3.5-5%. NAFLD occurs in patients of both genders, all ethnicities and in all age groups, including children. Nonetheless, when compared with non-Hispanic whites, NAFLD seems to be more prevalent among Hispanics and less prevalent among non-Hispanic blacks.
In addition to the high prevalence of NAFLD, its potential to progress has an important impact; NAFLD subtypes differ in their potential for progression. Although most patients with simple steatosis do not progress, 10-15% with histologically proven NASH do progress to cirrhosis and its complications such as liver failure, and hepatocellular carcinoma. These rates were initially reported by tertiary care institutions, but have been confirmed by more rigorous studies that have examined sequential liver biopsies and community cohort data. A long-term follow-up study of NAFLD patients showed that patients with NASH have lower survival rates. Additionally, most of the patients in the follow-up period developed type-2 diabetes or impaired glucose tolerance. Finally, a recent population study based on the NHANES III database showed that subjects with a presumed diagnosis of NAFLD have higher liver-related and all-cause mortality than those without liver disease. Another line of evidence suggesting a progressive course for NASH comes from data obtained from patients with the diagnosis of cryptogenic cirrhosis, which accounts for about 10% of liver transplants. Most cases of cryptogenic cirrhosis in the US are regarded as ‘burned out NASH’.
In short, both the prevalence and natural history of NAFLD suggest that it is a very common cause of liver disease and that its subtype, NASH, can progress to cirrhosis. These observations underscore the significant impact of NAFLD in terms of patient health, health-related quality of life and healthcare economics.
Background: Non-alcoholic fatty liver disease (NAFLD) is the hepatic manifestation of metabolic syndrome.
Aim: To assess the epidemiological impact and the current management of patients with NAFLD.
Methods: Published peer-reviewed literature and abstracts concerning NAFLD and non-alcoholic steatohepatitis (NASH) were reviewed. Articles specifically related to epidemiology, diagnosis and current treatment strategies for NAFLD and NASH are summarized.
Results: NAFLD is strongly associated with the epidemic of obesity and type-2 diabetes mellitus, and is estimated to affect about 20-30% of the population in the US. From the spectrum of NAFLD, only patients with biopsy-proven NASH (estimated prevalence in the US population is about 3-5%) have been convincingly shown to progress to cirrhosis, liver failure and hepatocellular carcinoma. The clinical manifestation of NAFLD is usually absent or subtle, with abnormal aminotransferases or incidental radiographic findings of fatty liver. The pathogenesis of NAFLD is attributed to a multi-hit process involving insulin resistance, oxidative stress, apoptotic pathways, and adipocytokines. In 2008, there is no established treatment for NAFLD. Weight loss and treatment for each component of metabolic syndrome. Nevertheless, a large number of agents are being considered in clinical trials of patients with NASH.
Conclusions: Awareness of the tremendous impact of NAFLD as an important cause of chronic liver disease is increasing along with a great deal of information about its pathogenesis. Future, well-designed clinical trials that target specific pathways involved in the pathogenesis of NASH are urgently needed.
Non-alcoholic steatohepatitis (NASH) was first described more than two decades ago and is now considered part of a spectrum of non-alcoholic fatty liver diseases (NAFLD). NASH resembles alcoholic steatohepatitis (ASH), but occurs in individuals who do not consume excessive amounts of alcohol. Both the more encompassing NAFLD and its progressive subtype, NASH, are considered to be the hepatic manifestation of metabolic syndrome.
Non-alcoholic fatty liver disease is the most common cause of chronic liver disease in the US. The estimated prevalence of NAFLD is 20-30% and for NASH it is estimated at 3.5-5%. NAFLD occurs in patients of both genders, all ethnicities and in all age groups, including children. Nonetheless, when compared with non-Hispanic whites, NAFLD seems to be more prevalent among Hispanics and less prevalent among non-Hispanic blacks.
In addition to the high prevalence of NAFLD, its potential to progress has an important impact; NAFLD subtypes differ in their potential for progression. Although most patients with simple steatosis do not progress, 10-15% with histologically proven NASH do progress to cirrhosis and its complications such as liver failure, and hepatocellular carcinoma. These rates were initially reported by tertiary care institutions, but have been confirmed by more rigorous studies that have examined sequential liver biopsies and community cohort data. A long-term follow-up study of NAFLD patients showed that patients with NASH have lower survival rates. Additionally, most of the patients in the follow-up period developed type-2 diabetes or impaired glucose tolerance. Finally, a recent population study based on the NHANES III database showed that subjects with a presumed diagnosis of NAFLD have higher liver-related and all-cause mortality than those without liver disease. Another line of evidence suggesting a progressive course for NASH comes from data obtained from patients with the diagnosis of cryptogenic cirrhosis, which accounts for about 10% of liver transplants. Most cases of cryptogenic cirrhosis in the US are regarded as ‘burned out NASH’.
In short, both the prevalence and natural history of NAFLD suggest that it is a very common cause of liver disease and that its subtype, NASH, can progress to cirrhosis. These observations underscore the significant impact of NAFLD in terms of patient health, health-related quality of life and healthcare economics.
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