Abstract
Nonalcoholic fatty liver disease (NAFLD) is currently the most common cause of chronic liver disease in industrialized countries worldwide, and has become a serious public health issue not only in Western countries but also in many Asian countries including Japan. Within the wide spectrum of NAFLD, nonalcoholic steatohepatitis (NASH) is a progressive form of disease, which often develops into liver cirrhosis and increases the risk of hepatocellular carcinoma. In turn, a large proportion of NAFLD/NASH is the liver manifestation of metabolic syndrome, suggesting that NAFLD/NASH plays a key role in the pathogenesis of systemic atherosclerotic diseases. Currently, a definite diagnosis of NASH requires liver biopsy, though various noninvasive measures are under development. The mainstays of prevention and treatment of NAFLD/NASH include dietary restriction and exercise; however, pharmacological approaches are often necessary. Currently, vitamin E and thiazolidinedione derivatives are the most evidence-based therapeutic options, although the clinical evidence for long-term efficacy and safety is limited. This practice guideline for NAFLD/NASH, established by the Japanese Society of Gastroenterology in cooperation with The Japan Society of Hepatology, covers lines of clinical evidence reported internationally in the period starting from 1983 to January 2012, and each clinical question was evaluated using the GRADE system. Based on the primary release of the full version in Japanese, this English summary provides the core essentials of this clinical practice guideline comprising the definition, diagnosis, and current therapeutic recommendations for NAFLD/NASH in Japan.
Highlights
Changes in diet and lifestyle have led to a dramatic increase in the prevalence of obesity and metabolic syndrome in Western countries and many Asian countries
Within the wide spectrum of Nonalcoholic fatty liver disease (NAFLD), nonalcoholic steatohepatitis (NASH) is a progressive form of disease, which often develops into liver cirrhosis and increases the risk of hepatocellular carcinoma
NAFLD consists of two clinical entities: nonalcoholic fatty liver (NAFL) and nonalcoholic steatohepatitis (NASH) [7,8,9,10,11]
Summary
Changes in diet and lifestyle have led to a dramatic increase in the prevalence of obesity and metabolic syndrome in Western countries and many Asian countries. In patients with NAFLD/NASH complicated by severe obesity, weight loss surgery is effective for improving the fatty changes in the liver and inflammation associated with NASH.
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