obesity + abnormal LFTs: ?NAFLD

Non-alcoholic fatty liver disease (NAFLD) is now the most common cause of liver disease in the developed world. It is largely caused by obesity and describes a spectrum of disease ranging from:

• steatosis - fat in >5% of the hepatocytes
• steatohepatitis - fat with inflammation, non-alcoholic steatohepatitis (NASH), see below
• progressive disease may cause fibrosis and liver cirrhosis

Cause:

NAFLD is thought to represent the hepatic manifestation of the metabolic syndrome and hence insulin resistance is thought to be the key mechanism leading to steatosis.

Non-alcoholic steatohepatitis (NASH) is a term used to describe liver changes similar to those seen in alcoholic hepatitis in the absence of a history of alcohol abuse. It is relatively common and thought to affect around 3-4% of the general population. The progression of disease in patients with NASH may be responsible for a proportion of patients previously labelled as cryptogenic cirrhosis.

Associated factors

• obesity
• type 2 diabetes mellitus
• hyperlipidaemia
• jejunoileal bypass
• sudden weight loss/starvation

PC