Fatty Liver Disease -- It's More Than Alcohol and Obesity

Heiner Wedemeyer, MD, Michael P. Manns, MD


July 23, 2003

In This Article

Definition of NAFLD, NASH, and ASH

NAFLD includes a spectrum of disorders characterized mainly by macrovesicular hepatic steatosis.[2] NAFLD can represent a broad spectrum of hepatic pathology, ranging from simple steatosis without any evidence of inflammation, to severe inflammatory activity with significant fibrosis or even cirrhosis.[3] The combination of steatosis and inflammation are the hallmarks of nonalcoholic steatohepatitis (NASH). Thus, to establish the diagnosis of NASH, a liver biopsy is, by definition, required.

NASH was first characterized by Ludwig and coworkers[4] at the Mayo Clinic in 1980. The differentiation of NASH from alcoholic steatohepatitis (ASH) may be difficult, because it is not known how much alcohol consumption is required to induce steatosis with inflammation. The amount of alcohol may vary with sex and genetic factors as well as with the capacity of antioxidative defense mechanisms. However, if ongoing alcohol consumption (of less than 20-30g per day) can be excluded, the diagnosis of NASH becomes likely.


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