Interní Med. 2015; 17(5): 224-226

Non-alcoholic fatty liver in clinical practice

prof.MUDr.Petr Hůlek, CSc.¹, MUDr.Irma Dresslerová²

¹ II. interní gastroenterologická klinika LF UK Hradec Králové

² I. interní kardioangiologická klinika FN Hradec Králové

Metabolic syndrome (MS) is one of the most widely spread diseases in so-called developed countries that is closely linked to the occurrence

of cardiovascular as well as other diseases. Abdominal obesity with excess visceral fat and the associated insulin resistance is the main

feature. Other main features include impaired glucose metabolism, dyslipidaemia, and arterial hypertension. Metabolic syndrome is

closely related to hepatic steatosis that, in the majority of cases, is a benign and reversible liver injury. Under certain circumstances,

however, simple steatosis can be accompanied by an inflammatory component and the condition may progress to NASH (non-alcoholic

steatohepatitis) and liver fibrosis, ultimately resulting in liver cirrhosis and hepatocellular carcinoma. In the English literature, these

particular stages of liver disease (simple hepatic steatosis, steatohepatitis, fibrosis, and cirrhosis) are collectively referred to as NAFLD

(non-alcoholic fatty liver disease). While simple steatosis is not dangerous to the sufferer, NASH is the beginning of the development of

cirrhosis. The aetiopathogenesis of NASH shares common features with that of insulin resistance and metabolic syndrome. Although

liver biopsy remains the gold standard of diagnosis, novel diagnostic procedures seem to be emerging that could distinguish simple

steatosis from NASH in a non-invasive manner. The treatment involves lifestyle measures and drugs reducing insulin resistance, thus

also used in the treatment of type 2 diabetes; in addition, a number of other drugs are also being tested. So far, however, there is a lack

of randomized, double-blind, placebo-controlled studies wherein the treatment outcome would be confirmed by histology. A number

of issues still remain to be elucidated in both the aetiopathogenesis of NAFLD and NASH and in their diagnosis and treatment.

Keywords: metabolic syndrome, steatosis, NAFL, NAFLD, NASH, insulin resistance

Published: December 1, 2015  Show citation