Tuesday, February 6, 2018

NAFLD: The evolving landscape

The Journal of Hepatology
February 2018
Volume 68, Issue 2, Pages 227–229

DOI: https://doi.org/10.1016/j.jhep.2017.11.016

NAFLD: The evolving landscape
Jacob George, Quentin Anstee, Vlad Ratziu, Arun Sanyal

Non-alcoholic fatty liver disease (NAFLD) comprising non-alcoholic fatty liver (NAFL) and non-alcoholic steatohepatitis (NASH), together with their complications of cirrhosis, liver failure and liver cancer will be the predominant liver disease for the conceivable future. Traditionally, viral hepatitis has been the focus of basic and clinical research, and the bread and butter for clinicians in the field. However, with the advent of therapies that suppress hepatitis B virus replication and the shift in standard of care for the treatment of hepatitis C to highly effective direct acting antivirals, the focus of clinical practice and research has altered. For hepatitis C, the goal has moved to elimination strategies and the massive treatment scale up required to achieve this outcome. For hepatitis B, lifelong antiviral therapy for those that require it, as well as cancer surveillance for at-risk groups, has established a relatively easy to follow management algorithm, as we transition to global hepatitis B eradication through immunisation and development of strategies to achieve a functional cure.

While these achievements are a highlight for the speciality, NAFLD has now replaced viral hepatitis as the mainstay of clinical hepatology. Not only does NAFLD and its many variations comprise an ever-increasing number and proportion of referrals to specialists, but it also represents a challenge for primary care physicians managing the early and intermediate stages of the disease. In this respect, disease due to fatty liver is a relative late comer to the limelight in Hepatology, compared to the consequences of the same systemic metabolic derangements to other organ systems including type 2 diabetes, cardiovascular and cerebrovascular disease, and chronic kidney disease.

As we move towards a world where the glimmer of viral hepatitis elimination is becoming a possibility and NAFLD related disease increases, it is appropriate that the Journal commissioned this supplement.

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