Hosted by Ray Shields, MD

NAFLD and NASH represent a spectrum of disease from simple fatty liver (steatosis) to steatosis with inflammation, necrosis, and cirrhosis.   NAFLD occurs in people who drink little or no alcohol and affects all age groups.  NASH represents the more severe end of this spectrum and it is associated with liver disease that progresses to fibrosis and cirrhosis. 

The etiology of NASH and the cellular basis for fat accumulation in the liver is unclear. Most patients with NASH are obese and have associated type 2 diabetes, hypertension, dyslipidemia, and insulin resistance.

The diagnosis is often made during a work-up of persistent AST/ALT elevation.  Liver imaging studies with ultrasound or CT scan may show evidence of fat infiltration in the liver.  Providers should eliminate other possible causes for chronic liver disease through tests such as viral and autoimmune testing for liver disease.  The gold standard diagnostic test is a liver biopsy. 

Treatment for both NAFLD and NASH include weight loss, exercise, improved diabetes and lipid control.  Glycemic control medications that reduce insulin resistance, such as metformin and the TZDs, have been shown to improve serum AST/ALT and liver pathology through increasing insulin sensitivity.