SOURCE: Rinella ME. Nonalcoholic fatty liver disease: A systematic review. JAMA 2015;313:2263-2273.

Epidemiologic insights about disease prevalence might sometimes be perceived as belaboring the obvious. After all, who doesn’t know that obesity has become an epidemic, that diabetes prevalence continues to rise unabated, and that hepatitis C is currently the most common cause of end-stage liver disease. Nevertheless, new epidemiologic sirens may sometimes awaken our motivation to address what might otherwise remain silent health burdens, with nonalcoholic fatty liver disease (NAFLD) being an excellent case-in-point.

Even the moniker “NAFLD” presumes we might automatically consider alcohol to be the default cause of fatty liver disease. While that might have been the case decades ago, the dual burdens of obesity and diabetes — both of which are direct antecedents to NAFLD — have changed the map of fatty liver disease on a global basis.

NAFLD portends important downstream consequences. Up to 30% of people with NAFLD have steatohepatitis, among whom approximately 20% will ultimately progress to cirrhosis. Since as many as 75 million to 100 million U.S. adults have NAFLD, this presents an epidemiologically compelling burden. Lifestyle intervention, when it leads to weight loss, is successful in improving liver pathology. There is some suggestion that independent of weight loss, a Mediterranean diet may have particular advantage.

Although no medication has been FDA approved to treat nonalcoholic steatohepatitis, some clinical data is supportive of pioglitazone (30 mg/d) or vitamin E (800 IU/d).

Clinicians should maintain vigilance as recommendations for identification and management of NAFLD evolve.