The dilemma of invasive and non-invasive investigations for adult and paediatric non-alcoholic fatty liver disease: has the time come for a new biochemical marker?

摘要

Non-alcoholic fatty liver disease (NAFLD) is the most common cause of liver dysfunction, as determined by liver function testing, and it has been estimated that, with increasing levels of obesity in the USA, 20 million patients are affected. NAFLD represents a spectrum of diseases, ranging from simple fatty liver (steatosis) to steatosis with inflammation and necrosis to cirrhosis that occurs in individuals who drink little or no alcohol. Non-alcoholic steatohepatitis (NASH) represents the more severe end of this spectrum and is associated with progressive liver disease, fibrosis and cirrhosis. The major risk factors are obesity and insulin resistance, and the prevalence of these risk factors has increased rapidly throughout the world. NAFLD is rapidly becoming an important problem. Undiagnosed, this condition may progress silently and result in cirrhosis, portal hypertension, and liver-related death in early adulthood. Recently the increase or decrease in alanine aminotransferase (ALT) has been used as a marker to diagnose or monitor treatment for NASH.