Non-alcoholic fatty liver disease: natural history, pathogenesis and treatment

Norma C Mcavoy

Liver Unit, Royal Infirmary of Edinburgh, Edinburgh, UK

James W Ferguson

Medical Unit, Royal Victoria Hospital, Kirkcaldy, UK

Ian W Campbell

Medical Unit, Royal Victoria Hospital, Kirkcaldy, UK

Peter C Hayes

Liver Unit, Royal Infirmary of Edinburgh, Edinburgh, UK

Non-alcoholic fatty liver disease (NAFLD) is the term used to describe the alcohol-like liver injury that occurs in the absence of alcohol abuse. It embraces a range of histological abnormalities including simple steatosis or fatty liver, non-alcoholic steatohepatitis (NASH) and NAFLD induced cirrhosis. The predominant risk factor for NAFLD appears to be insulin resistance. Simple steatosis and NASH are generally asymptomatic and it is only the development of cirrhosis that has clinical consequence. At present, therapy in NAFLD concentrates on managing risk factors but in the future clinical trials may provide robust evidence for the use of insulin sensitising agents and other potential therapies.