Nonalcoholic Fatty liver disease from the perspective of an internist.

Nonalcoholic fatty liver disease (NAFLD) is increasingly recognized as one of the most common causes of chronic hepatitis. While it has an indolent course in most patients, progression to cirrhosis is seen in some. Epidemiological data suggest that NAFLD may be the underlying disease in some patients with so called cryptogenic cirrhosis. Its incidence is likely to increase along with the current epidemiological trends in obesity. An increasing number of observations link insulin resistance as the central mechanism for hepatic steatosis. The factors that determine the progression of the disease, however, remain unclear. A clinical diagnosis is possible in most patients and liver biopsy is seldom required. While weight loss remains the most effective treatment, trials with insulin sensitizing agents are underway. There are some animal data as well as preliminary human data showing that metformin might offer some benefit in NAFLD. Liver transplantation is the treatment of choice for patients with decompensated cirrhosis.