Review
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Jun 8, 2017; 9(16): 715-732
Published online Jun 8, 2017. doi: 10.4254/wjh.v9.i16.715
Non-alcoholic fatty liver disease: An expanded review
Mark Benedict, Xuchen Zhang
Mark Benedict, Xuchen Zhang, Department of Pathology, Yale University School of Medicine, New Haven, CT 06510, United States
Author contributions: Benedict M wrote the paper; Zhang X edited, revised and contributed with conceptual development.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Xuchen Zhang, MD, PhD, Department of Pathology, Yale University School of Medicine, 310 Cedar Street, LH 108, PO Box 208023, New Haven, CT 06520, United States. xuchen.zhang@yale.edu
Telephone: +1-203-7856010 Fax: +1-203-7872922
Received: December 16, 2016
Peer-review started: December 19, 2016
First decision: January 28, 2017
Revised: February 8, 2017
Accepted: April 18, 2017
Article in press: April 20, 2017
Published online: June 8, 2017
Processing time: 171 Days and 2.8 Hours
Abstract

Non-alcoholic fatty liver disease (NAFLD) encompasses the simple steatosis to more progressive steatosis with associated hepatitis, fibrosis, cirrhosis, and in some cases hepatocellular carcinoma. NAFLD is a growing epidemic, not only in the United States, but worldwide in part due to obesity and insulin resistance leading to liver accumulation of triglycerides and free fatty acids. Numerous risk factors for the development of NAFLD have been espoused with most having some form of metabolic derangement or insulin resistance at the core of its pathophysiology. NAFLD patients are at increased risk of liver-related as well as cardiovascular mortality, and NAFLD is rapidly becoming the leading indication for liver transplantation. Liver biopsy remains the gold standard for definitive diagnosis, but the development of noninvasive advanced imaging, biochemical and genetic tests will no doubt provide future clinicians with a great deal of information and opportunity for enhanced understanding of the pathogenesis and targeted treatment. As it currently stands several medications/supplements are being used in the treatment of NAFLD; however, none seem to be the “magic bullet” in curtailing this growing problem yet. In this review we summarized the current knowledge of NAFLD epidemiology, risk factors, diagnosis, pathogenesis, pathologic changes, natural history, and treatment in order to aid in further understanding this disease and better managing NAFLD patients.

Keywords: Non-alcoholic fatty liver disease; Metabolic syndrome; Steatohepatitis; Hepatocellular carcinoma; Steatosis

Core tip: Non-alcoholic fatty liver disease (NAFLD) is a growing epidemic, not only in the United States, but worldwide in part due to obesity and insulin resistance leading to liver accumulation of triglycerides and free fatty acids. NAFLD patients are at increased risk of liver-related as well as cardiovascular mortality, and NAFLD is rapidly becoming the leading indication for liver transplantation. Numerous risk factors for the development of NAFLD have been espoused with most having some form of metabolic derangement or insulin resistance at the core of its pathophysiology. However, the exact pathogenic mechanism of NAFLD still remains unclear, and there is no effective treatment yet so far. In this review we summarized the current knowledge of NAFLD epidemiology, risk factors, diagnosis, pathogenesis, pathologic changes, natural history, and treatment.