I am seeing fatty liver more frequently as an incidental finding in patients undergoing abdominal ultrasound for GI complaints without a history of alcohol abuse or liver disease (particularly in middle-aged, slightly obese women). Does this progress to a more serious problem if not treated? What is the proper treatment?
—Jean Marsalla, ANP, Tucson, Ariz.

Nonalcoholic fatty liver disease (NAFLD) is rapidly emerging as the leading cause of abnormal liver enzymes in the United States. While its exact pathologic mechanism has yet to be determined, the end result is deposition of fat in the hepatocyte (hepatic steatosis). NAFLD is commonly seen in association with obesity (particularly central adiposity), diabetes mellitus, hypothyroidism, hyperlipidemia, and hypertriglyceridemia. NAFLD has been referred to as the “hepatic component” of the metabolic syndrome.

There is a spectrum of disease associated with fatty liver disease, ranging from simple steatosis without liver inflammation or fibrosis to nonalcoholic steatohepatitis with hepatic inflammation and fibrosis, which has the potential to progress to cirrhosis. Currently, liver biopsy is the only way to determine where along the spectrum an individual lies.

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Management of NAFLD primarily involves modest weight loss not to exceed one to two pounds per week. (Rapid weight loss can worsen the condition and even lead to severe hepatic compromise). Diabetes, hyperlipidemia, hypertriglyceridemia, and hypothyroidism should also be aggressively managed.

Pharmacologic therapy is being studied. Ursodiol (Actigall), vitamin E, and pioglitazone (Actos) have been assessed in the treatment of NAFLD, but effectiveness is still being evaluated.
—Bruce D. Askey, MSN, CRNP