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. 2014 Apr;10(4):219-27.

Controversies in the Diagnosis and Management of NAFLD and NASH

Mary E Rinella  1 , Rohit Loomba  1 , Stephen H Caldwell  1 , Kris Kowdley  1 , Michael Charlton  1 , Brent Tetri  1 , Stephen A Harrison  1
Affiliations

Controversies in the Diagnosis and Management of NAFLD and NASH

Mary E Rinella et al. Gastroenterol Hepatol (N Y). 2014 Apr.

Abstract

Nonalcoholic fatty liver disease (NAFLD) is recognized as the most common cause of chronic liver disease in the United States. Nonalcoholic steatohepatitis (NASH) occurs in a subset of patients with NAFLD and is characterized by the presence of hepa-tocellular injury, which is progressive in a substantial proportion of cases and can lead to cirrhosis and all of its complications. Although the diagnosis of NAFLD can be made through imaging studies or liver biopsy, the diagnosis of NASH still requires histologic confirmation. Liver biopsy should be performed in the presence of risk factors for advanced disease. Measures aimed at promoting weight loss, a healthier lifestyle, and optimization of metabolic risk factors remain the cornerstone of management of NAFLD. Therapeutic agents that are presently considered the most promising in NAFLD are effective in less than 50% of patients. Among patients with biopsy-proven NASH, treatment with pharmacologic agents should be considered; however, the role of specific agents in NASH still needs further study. Despite a wealth of research over the past 15 years, many controversies remain with respect to the diagnosis and management of NAFLD and NASH as well as the influence of alcohol on liver disease progression in these patients.

Keywords: Controversies in fatty liver disease; nonalcoholic fatty liver disease; nonalcoholic steatohepatitis.

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Figures

Figure.
Figure.
A proposed algorithm for the decision to obtain a liver biopsy in patients with presumed NAFLD after negative serologic evaluation and exclusion of alcohol as a contributing factor. Although the data are not as strong, serologically calculated fibrosis indices can be used in addition to or in lieu of imaging. *Diabetes/glucose intolerance, age greater than 65 years, hypertension, body mass index greater than 30 kg/m2, high triglycerides/low high-density lipoprotein, family history of diabetes, and aspartate aminotransferase level greater than alanine aminotransferase level. LCTs, liver chemistry tests; NAFLD, nonalcoholic fatty liver disease; US, ultrasound.
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