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Arch Hellen Med, 27(2), March-April 2010, 165-179


Current opinions about non-alcoholic fatty liver disease

Second Department of Medicine, Medical School, University of Athens, "Hippokration" General Hospital, Athens, Greece

Non-alcoholic fatty liver disease (NAFLD) is a spectrum of metabolic liver disease that extends from bland steatosis, through steatohepatitis, with liver cell injury, inflammation, pericellular fibrosis and non-alcoholic steatohepatitis (NASH), to some cases of "cryptogenic cirrhosis" and hepatocellular carcinoma, in the absence of excess alcohol intake. NAFLD/NASH affects a large proportion (20-40%) of the world's population. Insulin resistance and oxidative stress play critical roles in the pathogenesis of NAFLD/NASH, which can be regarded as the hepatic manifestation of the metabolic syndrome in >85% cases. Liver biopsy continues to be the most sensitive and specific means of prognosis. Simple steatosis has an excellent prognosis but steatohepatitis has the potential to progress to fibrosis and cirrhosis. Clinical studies have revealed a significant correlation between NAFLD/NASH and cardiovascular disease and increased intima media thickness. The logical approach to prevention or reversal of NAFLD/NASH is to correct insulin resistance, obesity (especially central obesity), diabetes mellitus and lipid disorders by lifestyle modification (i.e., increased physical activity, dietary modification). Weight reduction and bariatric surgery improve liver function abnormalities. Among the recommended drug treatment options for NASH are the agents that improve insulin sensitivity, and particularly the thiazolidinediones (rosiglitazone, pi╬┐glitazone) appear to be the most promising. Antioxidants (vitamin E, probuchol) and "hepatocellular protectants" (ursodeoxycholic acid) have also been used in clinical trials. This review focuses on the recent developments in the diagnosis and treatment of NAFLD/NASH.

Key words: Cryptogenic cirrhosis, NAFL, NASH, non-alcoholic fatty liver disease, non-alcoholic steatohepatitis.

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