ABSTRACT
Denitions ...................................................................................................................................... 116 Epidemiology ................................................................................................................................. 116 Clinical Features ............................................................................................................................ 117 Comorbid Conditions ..................................................................................................................... 117 Pathophysiology ............................................................................................................................. 117 Insulin Resistance .......................................................................................................................... 118 Pathogenesis of NASH and Fibrosis .............................................................................................. 120
Lipotoxicity ............................................................................................................................... 120 Endoplasmic Reticulum Stress .................................................................................................. 120 Skeletal Muscle Insulin Resistance ........................................................................................... 120 NALFD and Liver Fibrosis ....................................................................................................... 121 Gut Microbiota and NAFLD ..................................................................................................... 121 Genetic Risk Factors ................................................................................................................. 121
Diagnosis ........................................................................................................................................ 122 Laboratory Tests ........................................................................................................................ 122 Imaging Modalities ................................................................................................................... 123 Histology ................................................................................................................................... 123
Natural History ...............................................................................................................................124 Liver Transplantation ..................................................................................................................... 125 Treatment ....................................................................................................................................... 125
Lifestyle Modications ............................................................................................................. 126 Adjunct Weight Loss Pharmacotherapy .................................................................................... 127 Bariatric Surgery ....................................................................................................................... 127
Insulin Sensitizers and Other Diabetes Medications ..................................................................... 127 Metformin ................................................................................................................................. 127 Thiazolidinediones .................................................................................................................... 127 GLP-1 Analogues ...................................................................................................................... 128 Antioxidants and Cytoprotective Agents ................................................................................... 128
Vitamin E .............................................................................................................................. 128 Betaine .................................................................................................................................. 128 Ursodeoxycholic Acid .......................................................................................................... 128 Pentoxifylline ....................................................................................................................... 128 Other Agents ......................................................................................................................... 128
Summary ........................................................................................................................................ 129 Acknowledgment ........................................................................................................................... 129 References ...................................................................................................................................... 129
Nonalcoholic fatty liver disease (NAFLD) is an umbrella diagnosis that includes isolated fatty liver (IFL) and nonalcoholic steatohepatitis (NASH). Histologically, NAFLD resembles alcoholic liver disease. It is dened by the presence of macrovesicular fat in more than 5% of hepatocytes in patients without a history of excessive alcohol consumption.
