ABSTRACT
The close association between obesity and liver disease is manifested in nonalcoholic fatty liver disease (NAFLD), as obesity and related metabolic disorders are pathogenic drivers of this hepatic condition. About 25% of the general population and about 70% of people with obesity are affected by NAFLD. NAFLD can progress from simple steatosis to nonalcoholic steatohepatitis (NASH). The most important prognostic factor in NAFLD is the degree of fibrosis. Cardiovascular and non-hepatic mortality play a role in non-cirrhotic NAFLD patients, whereas in patients with manifest cirrhosis, the complications of advanced liver disease determine prognosis, especially the development of hepatocellular carcinoma (HCC). In NAFLD, HCC can also develop in non-cirrhotic livers. In addition, obesity has a central influence on chronic liver diseases and their prognosis. It can be considered an independent risk factor for liver decompensation, as well as acute-on-chronic liver failure (ACLF) in patients with cirrhosis, and appears to increase the risk of developing HCC regardless of the underlying liver disease. The cornerstone of NAFLD therapy is lifestyle modification, including weight reduction, Mediterranean diet, and exercise. Currently, there is no approved drug treatment for NAFLD, but there are many promising compounds in clinical trials.
