Categories: Gastrointestinal

NAFLD vs. NASH

Nonalcoholic fatty liver disease (NAFLD) affects over 1/4th of the world’s population. It has become the leading cause of cirrhosis in developed western countries. NAFLD and NASH exist along a spectrum. 

NAFLD: Patients are usually asymptomatic and the condition is found incidentally. It is defined as:  >5% of hepatic steatosis in patients who do not consume excessive alcohol. They will not have hepatocellular injury (∼80% of patients have normal-range ALT levels).

Approximately 10–30% will progress to non-alcoholic steatohepatitis (NASH). Which is differentiated by inflammation and hepatocellular injury (elevated ALT>AST). Its the active form of NAFLD, with hepatic necro-inflammation and faster fibrosis progression.

REFERENCES

1) Dyson JK, Anstee QM, McPherson S. Non-alcoholic fatty liver disease: a practical approach to diagnosis and staging. Frontline Gastroenterology 2014;5:211-218.

2) Chalasani N, Younossi Z, Lavine JE, Charlton M, Cusi K, Rinella M, Harrison SA, Brunt EM, Sanyal AJ. The diagnosis and management of nonalcoholic fatty liver disease: Practice guidance from the American Association for the Study of Liver Diseases. Hepatology. 2018 Jan;67(1):328-357. doi: 10.1002/hep.29367. Epub 2017 Sep 29. 

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Dr. C Humphreys

Internal Medicine

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