NAFLD: a critical appraisal by the clinician

• Liver biopsy remains the only diagnostic tool to stage NAFLD and to assess disease progression; clinical/biochemical parameters may be used as surrogate markers, but their accuracy is limited • The presence of multiple features of the metabolic syndrome is associated with more advanced and more progressive disease • Obesity and diabetes are associated with more aggressive liver disease, but their effect on final outcome is uncertain • Cardiovascular risk may compete with liver disease-related risk in dictating the final outcome • Longitudinal studies based on liver biopsy data are needed to define the natural history of disease