Enfermedad hepática grasa no alcohólica: ¿en qué vamos?

Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease worldwide. It affects approximately 3 out of 10 patients and, if not treated promptly, it could lead to cirrhosis and progress to hepatocellular carcinoma (HCC). NAFLD is defined as >5% fatty infiltration of liver parenchyma documented by biopsy; if there is also evidence of inflammation and lobar degeneration, it is called non-alcoholic steatohepatitis (NASH). The main risk factors associated with this condition are being overweight or obese, diets rich in refined carbohydrates and ultra-processed foods, type 2 diabetes mellitus, sedentary lifestyle, and metabolic syndrome. This promotes an increase in the visceral adipose compartment, insulin resistance and a disproportionate increase in fatty acid deposits in the liver. Patients are generally asymptomatic and are diagnosed taking into account risk factors, documentation of hepatic steatosis by imaging or biopsy, exclusion of other causes of hepatic steatosis and absence of pre-existing chronic liver disease. Treatment is based on a multidisciplinary approach seeking weight loss, regular physical activity and a healthy diet; however, in certain selected cases, vitamin E should be started. Some patients who have not received adequate treatment will require liver transplantation, especially if there is end-stage liver disease.