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Nonalcoholic fatty liver disease: from pathogenesis to patient care

Nature Clinical Practice Endocrinology & Metabolism volume 3, pages 458–469 (2007)Cite this article

Abstract

Nonalcoholic fatty liver disease (NAFLD) is the most common liver disease in Western countries. It encompasses a wide spectrum of liver lesions, from pure steatosis to end-stage liver disease with cirrhosis and hepatocellular carcinoma. Nonalcoholic steatohepatitis corresponds only to one stage of NAFLD. As NAFLD can be considered a liver manifestation of the metabolic syndrome, its prevalence is high in obese people and in patients who have type 2 diabetes—insulin resistance is one of the key elements of the pathogenesis of NAFLD. This disease is often asymptomatic in the absence of decompensated cirrhosis, but should be suspected in patients with elevated aminotransferase levels or radiological evidence of a fatty liver or hepatomegaly. Liver fibrosis is associated with age over 50 years, obesity, diabetes and high triglyceride levels. Liver biopsy is the only way to assess the histologic features of necrotic inflammation and fibrosis that define nonalcoholic steatohepatitis and to determine its probable prognosis. The prognosis is good for pure steatosis, whereas the presence of necrotic inflammation is associated with a significant risk of progression to cirrhosis and, possibly, hepatocellular carcinoma. Lifestyle changes, such as dietary modifications and exercise, are recommended. To date, there have been very few randomized, placebo-controlled trials of drug treatments for NAFLD.

Key Points

  • Nonalcoholic fatty liver disease (NAFLD) is the leading cause of liver disease in Western countries

  • NAFLD can be considered as a liver manifestation of the metabolic syndrome

  • Clinical symptoms are nonspecific and are frequently absent in patients without cirrhosis

  • Liver biopsy remains the gold standard for evaluation of prognosis

  • NAFLD can progress to cirrhosis and hepatocellular carcinoma

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Figure 1: Metabolic alterations that result in steatosis in nonalcoholic fatty liver disease
Figure 2: From steatosis to steatohepatitis
Figure 3: Proposed algorithm for the diagnosis, confirmation, and treatment of NAFLD

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Authors and Affiliations

  1. Department of Hepatology and Gastroenterology, Department of Hepatology and Gastroenterology, G Perlemuter is Professor of Hepatology in Assistance Publique—Hôpitaux de Paris, Hôpital Antoine Béclère, University Paris-South 11, and Head of the INSERM Avenir team, INSERM U764; S Naveau is Professor of Hepatology and Head of Assistance Publique—Hôpitaux de Paris, Hôpital Antoine Béclère, University Paris-South 11, all in Clamart, France.,

    Gabriel Perlemuter, Amélie Bigorgne, Anne-Marie Cassard-Doulcier & Sylvie Naveau

  2. A Bigorgne is a PhD student and A-M Cassard-Doulcier is a researcher in the INSERM Avenir team,

    Gabriel Perlemuter, Amélie Bigorgne, Anne-Marie Cassard-Doulcier & Sylvie Naveau

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Correspondence to Gabriel Perlemuter.

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Perlemuter, G., Bigorgne, A., Cassard-Doulcier, AM. et al. Nonalcoholic fatty liver disease: from pathogenesis to patient care. Nat Rev Endocrinol 3, 458–469 (2007). https://doi.org/10.1038/ncpendmet0505

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