COMMENTARY

Nonalcoholic Fatty Liver Disease

Pouneh S. Mofrad, MD, Arun J. Sanyal, MD

Disclosures

April 16, 2003

In This Article

Conclusion

NAFLD is a common cause of chronic liver disease in North America; it is most often associated with obesity. Other risk factors associated with NAFLD include diabetes, use of specific drugs (eg, nucleoside analogs), jejunoileal bypass, severe rapid weight loss, lipodystrophic syndromes, and use of total parenteral nutrition. The hepatic histology may show either a fatty liver alone or steatohepatitis. Steatohepatitis may progress to cirrhosis in some patients; this condition is characterized by a long asymptomatic period. Hepatomegaly is the most common physical finding in patients with NAFLD. The serum AST and ALT levels are often elevated to 1-4 times the upper limit of normal. The AST:ALT ratio is usually < 1. Diagnosis depends on demonstration of appropriate hepatic histology and absence of alcohol use in quantities known to be harmful to the liver (20-30 g/day). A liver biopsy is usually required when the diagnosis is in doubt or if the disease must be staged. Treatment involves optimization of weight status with the use of diet and exercise. The impact of additional therapy for weight loss on the liver remains to be defined. There is currently no established pharmacologic treatment of NAFLD, although early pilot clinical trials with vitamin E, ursodeoxycholic acid, and insulin sensitizers appear promising. Drugs with the potential for toxicity should not be used outside of the context of a clinical trial at this time.

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