Non-alcoholic steatohepatitis

Purpose of review Non-alcoholic fatty liver disease is an increasingly prevalent form of chronic liver disease that progresses to cirrhosis and hepatocellular carcinoma in a fraction of the overweight and sedentary population. Knowledge is advancing rapidly in describing the magnitude of the problem, how non-alcoholic fatty liver disease should be diagnosed, and what treatment options are available. This review examines data from the past year on key clinical aspects of non-alcoholic fatty liver disease. Recent findings New data on the epidemiology of non-alcoholic fatty liver disease, non-alcoholic steatohepatitis and insulin resistance is constantly emerging, and new treatment options are being evaluated. Using serum alanine aminotransferase elevations to identify patients with possible chronic liver diseases is unreliable and should possibly be abandoned. Similarly, ultrasound is unreliable in detecting non-alcoholic fatty liver disease in severely obese patients. Imaging by computed tomography or magnetic resonance may be used in high-risk groups, such as those with features of the metabolic syndrome, but cost-effective means of identifying patients with non-alcoholic steatohepatitis are not available. Treatment options include weight loss, exercise and drugs. Bariatric surgery may be beneficial with respect to liver disease. Summary The presence of non-alcoholic steatohepatitis should be sought in individuals with features of insulin resistance and other features of the metabolic syndrome, because these patients are most at risk of developing advanced liver disease. Current data indicate that lifestyle modifications that include weight loss and exercise should be the primary treatment option.