NAFLD

NAFLD, or non-alcoholic fatty liver disease, describes a spectrum of liver conditions in people who consume little or no alcohol. It ranges from simple hepatic steatosis to nonalcoholic steatohepatitis (NASH), which includes inflammation and injury that can progress to fibrosis and cirrhosis. NAFLD is strongly linked to metabolic risk factors such as obesity, insulin resistance, type 2 diabetes, dyslipidemia, and hypertension, and is a leading cause of chronic liver disease worldwide.

Most patients are asymptomatic; some report fatigue or discomfort. Diagnosis combines imaging evidence of steatosis with assessment of alcohol intake and exclusion of other causes. Ultrasound, CT, or MRI can detect fat, while elastography estimates fibrosis noninvasively. Liver biopsy remains the reference standard to distinguish NASH from simple steatosis and to stage fibrosis, but is used selectively. Noninvasive scoring systems and biomarkers help stratify fibrosis risk.

Management emphasizes lifestyle modification to reduce liver fat and improve metabolic risk factors. Achieving sustained weight loss (about 7–10%) through diet and physical activity improves steatosis and inflammation. There is no approved NAFLD-specific drug; vitamin E may help non-diabetic adults with NASH, and pioglitazone can benefit some patients. Statins are safe for coexisting dyslipidemia, and obesity-related surgery may be considered in appropriate candidates.

Prognosis varies; while many have stable disease, a subset progresses to advanced fibrosis and cirrhosis. Cardiovascular disease is a major cause of mortality in NAFLD, so management of metabolic risk factors is essential. Regular monitoring and risk stratification guide surveillance for disease progression and liver-related complications.