COMMENTARY

The Emerging Epidemic of Nonalcoholic Fatty Liver Disease

Rowen K. Zetterman, MD

Disclosures

January 21, 2011

In This Article

Clinical Course

NAFLD is underrecognized clinically. It is often identified only in patients with abnormal liver tests or enlarged livers. Whereas the diagnosis of NAFLD can be suspected by the presence of associated disorders or by ultrasound screening, the proven diagnosis rests on liver histology and exclusion of significant ethanol intake. The evaluation of patients suspected of having NAFLD should include confirmation of diagnosis, evaluation of their prognosis, and assessment of coexisting disorders.

In patients with pure fatty liver who lack necroinflammatory changes or NASH, progressive liver disease may not occur. In those with NASH, at least one third will have progressive disease.[36]In a recent trial, 22% of patients had progression of fibrosis, whereas fibrosis remained stable in 46% and regressed in 18% over 2 years.[37] Factors associated with development of advanced fibrosis in NASH include increased age, low initial fibrosis stage, and lobular inflammation at initial liver biopsy.[38]Hepatocellular carcinoma develops in 5%-7% of patients with cirrhosis or advanced fibrosis from NASH.[39,40]

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