Nonalcoholic Fatty Liver Disease and Metabolic Syndrome

onalcoholic fatty liver disease (NAFLD) is a con-dition characterized by significant lipid deposition greater than 5 % of the liver weight without any history of excessive alcohol intake. Now it refers to a spectrum of diseases of the liver ranging from steatosis fatty infiltration of the liver to NASH (steatosis with in-flammation and hepatocyte necrosis. It is the most common cause of elevated liver enzymes in adults in the United States.1 The prevalence of NAFLD ranges from 20 % to 30 % in the Western Population. The prevalence is higher in patients who have metabolic syndrome and in patients with insulin resistance. NAFLD is now recognized as an important childhood liver disease and is likely to reach epidemic proportions in children worldwide in the next decade.2 Metabolic syndrome is currently very commonly found both in obese adults and obese children. NAFLD now is a common feature of the metabolic syndrome. Definition and Classification NAFLD is considered when there is fat deposition more than 5 % of the hepatocytes. It is classified into 4 classes Class I simple hepatosteatosis Class II increased hepatosteatosis with or without NASH* Class III increased hepatosteatosis with NASH* Class IV increased hepatosteatosis with increased NASH* *NASH- nonalcoholic steatohepatitis Generally, NAFLD is associated with obesity, hyper-lipidemia and insulin resistance. This close association sug-gests pos-sible links between these disorders. On this basis, NAFLD has been included as part of the metabolic syn-drome. However, NAFLD can also occur in non-obese/ non-diabetic patients as well as in patients with lipodystrophy. Clinical course3 Simple forms of NAFLD are characterized by triglyceride accumulation in hepatocytes. This frequently is complicated by inflammation (NASH). NAFLD may progress to hepatitis, cirrhosis and to hepatocellular carcinoma. Simple steatosis may develop into NASH in one third of cases. A considerable subset (up to 50%) of NASH patients can develop fibrosis and about 15 % to 19 % develop cirrhosis. The risk of malignant complication in these patients is increased more than 4 times