Nonalcoholic Fatty Liver Disease: An Expanding Health Care Epidemic

Clinics in Liver Disease

Current Topic

February 2018
NASH and NAFLD

Nonalcoholic Fatty Liver Disease: An Expanding Health Care Epidemic
David E. Bernstein, MD, Editor

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Nonalcoholic fatty liver disease (NAFLD) has become a common worldwide condition, the prevalence of which continues to increase with the worldwide surge in the incidence of obesity and diabetes. In the United States alone, NAFLD affects between 60 and 100 million people, including 10% of American children. The spectrum of disease ranges from simple, nonclinically significant hepatic steatosis to steatohepatitis (NASH) to cirrhosis, hepatocellular carcinoma, and decompensated liver disease. In 2016, NAFLD was reported to surpass hepatitis C as the leading indication for liver transplantation among adults under the age of 50, and it is predicted to be the leading indication for liver transplantation in the next decade (Banini and Sanyal, Am J Gastroenterol 2016, Vol 111; Abstract 46).

NAFLD/NASH is the hepatic manifestation of the metabolic syndrome and therefore associated with hypertension, hyperlipidemia, diabetes, and obesity. Despite this association, NAFLD may occur in nondiabetic, nonobese individuals, suggesting that multiple mechanisms may exist for its development. Over the past decade, there have been significant advances in our understanding of the prevalence, natural history, genetics, evaluation, and treatment of NAFLD.

This issue of Clinics in Liver Disease provides an update to our current understanding of NAFLD as presented by a cadre of distinguished experts in the field. The first section reviews its clinical and economic burden, discusses the implication of NAFLD in children, and reviews the natural history of the disease. The second section discusses the diagnosis and evaluation of NAFLD/NASH, focusing on noninvasive serological markers, the role of liver biopsy, and an in-depth discussion of the use of radiological imaging. The third section concentrates on the pathophysiology, risk factors, genetics, and the role of intestinal microbes in the disease. The final section discusses associated conditions, reviews current and emerging treatments, and discusses the development of hepatocellular carcinoma and the role of liver transplantation in NAFLD/NASH.

Our understanding of NAFLD/NASH continues to grow at a rapid pace, and keeping up with the latest information can be challenging. The contributors to this issue have worked hard to provide excellent, concise, up-to-date reviews of the topics listed above. I hope you enjoy their work, and I thank them all for their contributions

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February 2018 Volume 22, Issue 1, p1-228

NASH and NAFLD

Edited by David E. Bernstein