Nonalcoholic fatty liver disease (NAFLD) and cardiovascular disease. An overview

Nonalcoholic fatty liver disease (NAFLD) defines the most of common liver diseases encompassing alcohol-like hepatic histologic lesions seen in the non-alcoholic insulin resistant patient. NAFLD, deemed to be the hepatic counterpart of the metabolic syndrome, represents a multifactorial condition spanning the widespectrum from steatosis through non-alcoholic steatohepatitis (NASH) with or without (cryptogenic) cirrhosis. End-stage liver failure and hepatocellular carcinoma are observed in a yet undetermined proportion of individuals. Along with insulin resistance, additional endocrine and vascular changes play a prominent role in the development and progression of NAFLD. Genetic factors underlying NAFLD are being unravelled. Their understanding will further our understanding of pathogenesis and will also probably enhance non-invasive diagnosis. Diet and physical exercise represent, with the correction of predisposing metabolic changes, the mainstay of treatment. Insulin sensitizing drugs should better be used only in selected patients, preferably in the context of controlled clinical trials. Non-invasive evaluation of risk for cardiovascular events is recommended in all individuals presenting with NAFLD and conversely, the presence of NAFLD should be always looked for in subjects with features belonging to the metabolic syndrome.