Should nonalcoholic fatty liver disease be regarded as a hepatic illness only?

role in the disease development and progression. Our current knowledge of the natural history of NAFLD can be summarized as follows: elevated body mass index (BMI) plays a key role; simple steatosis NAFL (Fatty liver, FL) does not generally progress to Non-Alcoholic SteatoHepatitis (NASH); patients with NASH progress, in relatively many cases, to cirrhosis; older age and advanced fibrosis are risk factors for hepatocellular carcinoma (HCC) in NASH; up to a third of patients develop liver-related morbidity or mortality. It is extremely important that physicians diagnose NASH accurately and perform appropriate treatments, because it represents an illness mirroring a systemic process, and an adjunctive cardiovascular disease (CVD) risk [1] . A great deal of research highlight the need for surrogate serum markers for diagnosing NASH. Among them, serum cytokeratin 18 has captured certain interest [2] .