Nonalcoholic Fatty Liver Disease Assessment and Management
Summary
Nonalcoholic fatty liver disease (NAFLD) encompasses a spectrum from simple hepatic steatosis through nonalcoholic steatohepatitis (NASH) to progressive fibrosis and cirrhosis. It has become the most prevalent chronic liver condition worldwide, driven by obesity, type 2 diabetes and metabolic syndrome. Early identification relies increasingly on non-invasive tools, including imaging modalities and serum biomarker panels, which reduce reliance on liver biopsy. Transient elastography and enhanced liver fibrosis (ELF) scoring facilitate quantification of stiffness and fibrotic activity. Lifestyle modification with diet, weight reduction and physical activity remains first-line therapy; modest weight loss of 7–10% is associated with histological improvements. Emerging pharmacotherapies target insulin resistance, lipid handling and inflammatory pathways, with trials investigating agonists of peroxisome proliferator-activated receptors and inhibitors of fibrogenic signalling. A multidisciplinary approach, encompassing hepatology, endocrinology and nutrition, underpins effective management. Globally, NAFLD poses a substantial burden on healthcare systems, underlining the need for scalable screening programmes and integrative care models to mitigate progression to cirrhosis and hepatocellular carcinoma.
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Nonalcoholic Fatty Liver Disease Assessment and Management publication trend
The graph below shows the total number of articles in nonalcoholic fatty liver disease assessment and management across all publications each year (not limited to Nature Index journals).
Technical terms
Nonalcoholic fatty liver disease (NAFLD): Spectrum of liver disorders characterised by excess fat accumulation in hepatocytes in the absence of significant alcohol intake.
Nonalcoholic steatohepatitis (NASH): Progressive form of NAFLD marked by hepatic inflammation, hepatocyte injury and variable fibrosis.
Hepatic steatosis: Excessive intra-hepatic fat deposition detectable by imaging or histology.
Liver fibrosis: Accumulation of extracellular matrix proteins in the liver, leading to architectural distortion and impairment of function.
Transient elastography (TE): Ultrasound-based technique measuring liver stiffness as a surrogate for fibrosis.
Enhanced Liver Fibrosis (ELF) score: Composite serum biomarker panel quantifying fibrogenic activity.
Complement C5a receptor 1 (C5aR1): G-protein-coupled receptor for complement factor C5a implicated in inflammatory signalling and fibrogenesis.
References
- Risk of liver fibrosis associated with long-term methotrexate therapy may be overestimated. Journal of Hepatology (2023).
- Blockade of C5aR1 alleviates liver inflammation and fibrosis in a mouse model of NASH by regulating TLR4 signaling and macrophage polarization. Journal of Gastroenterology (2023).
- Liver fibrosis is closely linked with metabolic-associated diseases in patients with autoimmune hepatitis. Hepatology International (2024).
- From NAFLD in clinical practice to answers from guidelines. Journal of Hepatology (2013).
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