Chapter 7

From Fatty Liver to Cirrhosis: The Toll Rises!

Harmit S. Kalia and Allan W. Wolkoff

Abstract

Obesity is a growing epidemic affecting many races and nations. This rise is a major risk factor for many diseases including cardiovascular disease (CVD), diabetes mellitus (DM), certain malignancies and non-alcoholic fatty liver disease (NAFLD). NAFLD is now the most common cause of chronic liver disease in the US and many developed nations. Coexistence of DM and NAFLD can lead to progressive liver disease although mortality is usually due to CVD. The majority of NAFLD patients do not have progressive disease and liver biopsy is required to diagnose those individuals with non-alcoholic steatohepatitis (NASH) which can advance to cirrhosis and its complications. Several dietary, environmental and genetic factors may be important for the development of steatosis and progression of NASH. Although there have been several important observations regarding the pathophysiology of NASH, our understanding remains incomplete. Evaluation of NAFLD should include an assessment of contributory disorders such as metabolic syndrome and evaluation to rule out other causes of liver disease. The management of NAFLD is challenging as there is no effective drug therapy, and although lifestyle modification is often prescribed, clinical efficacy is usually low.

Total Pages: 114-131 (18)

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