NAFLD/NASH: A Growing Epidemic

Spectrum of Disease

NAFLD ranges from simple steatosis to NASH (steatosis with inflammation) and cirrhosis. Affecting 25% globally, it's closely associated with metabolic syndrome. Risk factors include obesity, diabetes, and dyslipidemia.

Diagnostic Approach

Elevated liver enzymes should prompt evaluation. Ultrasound detects steatosis, while FibroScan assesses fibrosis. The FIB-4 score helps risk-stratify. Liver biopsy remains gold standard for NASH diagnosis and staging.

Lifestyle Interventions

Weight loss of 7-10% can reverse NASH. Mediterranean diet improves liver enzymes and histology. 150-300 minutes weekly of moderate exercise provides benefit independent of weight loss.

Pharmacologic Options

Vitamin E and pioglitazone show benefit in biopsy-proven NASH. GLP-1 agonists demonstrate reduced liver fat. Several investigational drugs target different pathways in NASH pathogenesis.

Monitoring and Referral

Patients with advanced fibrosis require HCC surveillance. Referral to hepatology is recommended for NASH with fibrosis or diagnostic uncertainty. Comanagement with endocrinology optimizes metabolic parameters.