| Shrnutí: | Non-alcoholic fatty liver disease (NAFLD) is a global health problem, with an estimated prevalence of 30% among adults in industrialized countries, and associated with obesity and type 2 diabetes mellitus. NAFLD is defined histologically and represents a spectrum from simple steatosis to steatohepatitis, fibrosis and cirrhosis. Hepatic triglyceride droplet accumulation is considered the first feature in the natural history; in some patients, this is associated with inflammation and fibrosis, through the interaction of environmental and host factors. Patients with NAFLD are generally asymptomatic and usually present with incidental findings of abnormal liver function tests or an echo-bright liver on ultrasonography. Non-invasive tests are routinely used to stratify risk of advanced fibrotic disease, and liver biopsy is used in selected cases to assess for evidence of hepatic co-morbidity. Treatment is focused on weight reduction through dietary modifications and exercise. Cardiovascular risk factors should be addressed and the treatment of diabetes mellitus, hypertension and hyperlipidaemia optimized. Liver-specific treatments such as vitamin E and pioglitazone have shown benefit in clinical trials, but have not been widely adopted into clinical practice because of concerns over long-term safety. Several other agents including obeticholic acid are being evaluated in Phase II and III clinical trials.
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