Q J Med 2003; 96: 699-709
© 2003 Association of Physicians
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Non-alcoholic fatty liver: a common manifestation of a metabolic disorder
From the 1Department of Internal Medicine C, 2Gastroenterology Institute and 3Metabolic Unit, Kaplan Medical Centre, affiliated with Hadassah and the Hebrew University School of Medicine, Rehovot, Israel
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Introduction |
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Non-alcoholic fatty liver (NAFL) is one of the most common liver diseases encountered in the United States and Europe. This term refers to a spectrum of hepatic pathology that resembles alcoholic liver disease, but appears in individuals who have low or negligible alcohol consumption.
Initially the term non-alcoholic steatohepatitis (NASH) was employed by Ludwig et al. in 1980 to describe a syndrome in morbidly obese females with type 2 diabetes mellitus (DM), in whom the hepatic histology was consistent with alcoholic hepatitis, but there was no history of alcohol use.1 More recently it has become apparent that NAFL is a spectrum of disease (Table 1).
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It has been suggested that the term NASH should be used only for the more severe forms of NAFL that correspond to types 3 and 4 with alcoholic-like histological findings.2 As in alcoholic
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Prevalence |
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Risk factors |
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Obesity |
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Dyslipidaemia |
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Insulin resistance and type 2 DM |
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Pathophysiology |
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Natural history of NAFL |
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Clinical features and diagnosis |
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Clinical features
Laboratory features
Diagnosis
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Treatment |
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Dietary intervention
Treatment of associated insulin resistance
Lipid-lowering medications
Antioxidants
Ursodeoxycholic acid
Liver transplantation
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Conclusion |
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Address correspondence to Dr S.D.H. Malnick, Department of Internal Medicine C, Kaplan Medical Centre, Rehovot 76100, Israel. e-mail: stevash@trendline.co.il
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