Non-alcoholic fatty liver disease (
NAFLD) is an umbrella term for a series of hepatic pathologies that begin with relatively benign steatosis and can, with appropriate triggers, lead to the serious entity of non-
alcoholic steatohepatitis (NASH). This sets the stage for
liver fibrosis and finally the development of
cirrhosis in up to 20% of patients with NASH.
NAFLD, already among the most common diseases in industrialized countries, is increasing in prevalence and roughly affects 30% of US adults and 10% of US children alone.
NAFLD is strongly associated with
insulin resistance (IR) and represents the hepatic manifestation of the
metabolic syndrome. Indeed, treatments aimed at reducing IR are the current mainstay of therapeutic approaches to
NAFLD. While lifestyle interventions may produce limited degrees of success, there remains an urgent need for improved pharmacological
therapies. Emerging diagnostic and therapeutic opportunities as well as future developments in
NAFLD, NASH and
liver fibrosis were discussed by a panel of experts and are presented herein. Promising novel therapeutic targets include inhibitors of
dipeptidyl peptidase 4 and the renin-angiotensin system. However, improved non-invasive technologies to diagnose and stage
NAFLD are needed. Combined with a better understanding of the pathophysiological processes that underlie the mechanisms of hepatic fibrogenesis in NASH, rapid clinical validation of novel
therapies is expected.