Non-alcoholic fatty liver disease in 2016

Abstract

Introduction: Non-alcoholic fatty liver disease is the commonest cause of liver disease worldwide, and is rapidly becoming the leading indication for liver transplantation.

Sources of data: Original articles, reviews and meta-analyses, guidelines.

Areas of agreement: NAFLD strongly correlates with obesity and insulin resistance; currently, the best management strategy is weight loss and treatment of the metabolic syndrome.

Areas of controversy: Recent data suggest that the presence of fibrosis and not non-alcoholic steatohepatitis (NASH) is the predictor of clinical outcome.

Growing points: Many phase 2 and 3 trials are underway. Drugs hoped to be effective are obeticholic acid, elafibranor, glucagon-like peptide-1 analogues and CCR2/5 inhibitors.

Areas timely for developing research: Improved understanding of the pathophysiology of NAFLD should help us identify which patients progress to significant liver disease and to develop therapies to target this population.

Keywords: NASH; assessment; cardiovascular disease; fibrosis; metabolic syndrome; non-alcoholic fatty liver disease; obesity; treatment.