Recent advances in understanding and managing non-alcoholic fatty liver disease

Abstract

Non-alcoholic fatty liver disease is a leading cause of chronic liver disease that can lead to cirrhosis, hepatocellular cancer, and end-stage liver disease, and it is linked to elevated cardiovascular- and cancer-related morbidity and mortality. Insulin resistance related to metabolic syndrome is the main pathogenic trigger that, in association with adverse genetic, lifestyle, and other factors, precipitates the development of non-alcoholic fatty liver disease. Biochemical markers and radiological imaging, along with liver biopsy in selected cases, help in the disease's diagnosis and prognostication. Weight loss is the cornerstone treatment of non-alcoholic fatty liver disease; however, it is difficult to achieve and maintain, so pharmacotherapy was developed. The remarkable evolution in understanding disease pathogenesis has led to the development of new medical therapies and even the modification of currently available ones. This review summarizes recent advances in understanding the epidemiology, natural history, pathogenesis, diagnosis, and management of non-alcoholic fatty liver disease.

Keywords: Nonalcoholic fatty liver disease; Nonalcoholic steatohepatitis; cirrhosis; fibrosis.

Figure 1.. Targets of upcoming therapies for non-alcoholic fatty liver disease (NAFLD).

DNL, de novo lipogenesis; FGF, fibroblast growth factor; FMT, fecal microbial transplant; FXR, farnesoid X receptor; FXRE, FXR response element; GHRH, growth hormone-releasing hormone; GLP-1, glucagon-like peptide-1; PPAR, peroxisome proliferator-activated receptor; PPRE, PPAR response element; RXR, retinoid X receptor. Reprinted with permission from Rotman Y and Sanyal AJ. Current and upcoming pharmacotherapy for non-alcoholic fatty liver disease. Gut. 2017;66:180–190.