Hígado graso no alcohólico: certezas e incertidumbres de una epidemia silenciosa

Abstract

Nonalcoholic fatty liver disease (NAFLD) is the most frequent chronic liver disease, with an estimated prevalence of 20-30% in the general population and increased to 60-80% in risk groups. It encompasses the spectrum of diseases ranging from simple steatosis to nonalcoholic steatohepatitis (NASH), which can progress to variable degrees of fibrosis, cirrhosis and all its complications. It is associated with cardiovascular, neoplasm and liver mortality, requiring a multidisciplinary approach. A change in the entity name has recently been suggested and a group of experts has proposed calling it Metabolic (dysfunction) Associated Fatty Liver Disease (MAFLD). This name has not yet been accepted and has generated significant controversy. Due to the increase in its prevalence, nonalcoholic fatty liver disease has become a relevant health problem that requires specific actions for its detection, diagnosis, monitoring and treatment. Identifying patients at risk of progressing to more severe forms is essential but not too easy. Patients with nonalcoholic steatohepatitis should be identified; mainly those with fibrosis, the most important characteristic associated with mortality. The main treatment for all stages of the disease consists of lifestyle interventions and aggressive correction of comorbidities. Other therapies, such as treatment with pioglitazone or GLP-1RA, should be selected and used in patients with nonalcoholic steatohepatitis who are at higher risk of progression of liver and cardiovascular disease, like obese and type 2 diabetic patients.