A Quick synopis of AFP's "Nonalcoholic Fatty Liver Disease: Diagnosis and Management"

Nonalcoholic Fatty Liver Disease: Diagnosis and Management
THAD WILKINS, MD, Georgia Regents University, Augusta, Georgia, ALTAF TADKOD, MD, Barrow Regional Medical Center, Winder, Georgia, IRYNA HEPBURN, MD, Good Samaritan Digestive Health Specialists, Lebanon, Pennsylvania, ROBERT R. SCHADE, MD, University of Pittsburgh Medical Center Presbyterian, Pittsburgh, Pennsylvania
Am Fam Physician. 2013 Jul 1;88(1):35-42.
http://www.aafp.org/afp/2013/0701/p35.pdf

     Nonalcoholic fatty liver disease is defined as fatty infiltration of the liver without other causes of steatosis. It has increased in the population with the increase of metabolic syndrome, obesity, and a sedentary lifestyle. There will be hepatocyte ballooning, mallory hyaline, and mixed lymphocyte/neutrophilic inflammatory infiltrates.  Hepatic steatosis is defined as excessive accumulation of fat in the liver (fat in more than 5% of the liver cells). Nonalcoholic steatohepatitis is hepatic steatosis with inflammation and cell injury. 
     The exact mechanism of nonalcoholic fatty liver disease is unknown. Patients are often asymptomatic. Diagnosis is usually an incidental finding. Metabolic syndrome is associated with nonalcoholic fatty liver disease. The criteria for metabolic syndrome includes: 
     An elevated blood pressure (greater than 129 systolic or 85 diastolic) or on meds for hypertension,
     A fasting glucose above 99 mg/dL or on meds for high glucose,
     An HDL less than 50 in women or 40 in men, or on meds for low HDL,
     A triglyceride level above 149 mg/dL or on meds for high triglycerides,
     A waist circumference at or above 35' in women or 40' in men.
     Screening is not necessary, but for patients suspected of nonalcoholic fatty liver disease, a proper history and physical is needed. A full set of labs, including LFT's, ferritin, iron, A1C, lipids, cholesterol, and hepatitis panels should be drawn. Tests can also be done to rule out wilsons, hemochromatosis, a-antitrypsin deficiency, and autoimmune hepatitis. Ultrasound can be done to look for fat in the liver. It cannot, however differentiate steatosis from fibrosis. A CT or MRI may be needed if this is a concern. There are many serological markers for fibrosis which may defer the need for a biopsy. Biopsy is the definitive test in determining hepatic steatosis vs. nonalcoholic fatty liver disease. 
     Treatment is focused on lifestyle management. The main goal is to reduce insulin resistance.  A healthy diet,  weight loss, and exercise is the standard of care for nonalcoholic fatty liver disease. There is mixed information about pharmacology. Prevention includes vaccination for hepatitis A and B, and limiting alcohol use.