Nonalcoholic fatty liver disease (NAFLD) is a spectrum of disease, extending from simple steatosis to inflammation and fibrosis with a significant risk for the development of cirrhosis. It is highly prevalent and is associated with significant adverse outcomes both through liver-specific morbidity and mortality but, perhaps more important, through adverse cardiovascular and metabolic outcomes. It is closely associated with type 2 diabetes and obesity, and both of these conditions drive progressive disease toward the more advanced stages. The mechanisms that govern hepatic lipid accumulation and the predisposition to inflammation and fibrosis are still not fully understood but reflect a complex interplay between metabolic target tissues including adipose and skeletal muscle, and immune and inflammatory cells. The ability to make an accurate assessment of disease stage (that relates to clinical outcome) can also be challenging. While liver biopsy is still regarded as the gold-standard investigative tool, there is an extensive literature on the search for novel noninvasive biomarkers and imaging modalities that aim to accurately reflect the stage of underlying disease. Finally, although no therapies are currently licensed for the treatment of NAFLD, there are interventions that appear to have proven efficacy in randomized controlled trials as well as an extensive emerging therapeutic landscape of new agents that target many of the fundamental pathophysiological processes that drive NAFLD. It is highly likely that over the next few years, new treatments with a specific license for the treatment of NAFLD will become available.

中文翻译：

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成人非酒精性脂肪肝疾病：病因学，结果和管理的最新概念。

非酒精性脂肪肝疾病（NAFLD）是一种疾病，从单纯的脂肪变性扩展到炎症和纤维化，具有发展为肝硬化的重大风险。它是非常普遍的疾病，并通过肝脏特定的发病率和死亡率与重大的不良后果相关，但更重要的是，由于不良的心血管和代谢结果而与之相关。它与2型糖尿病和肥胖症密切相关，这两种情况都将进行性疾病推向更晚期。尚不完全了解控制肝脂质蓄积以及易发炎症和纤维化的机制，但反映了代谢目标组织（包括脂肪和骨骼肌）与免疫和炎性细胞之间的复杂相互作用。对疾病阶段（与临床结果相关）进行准确评估的能力也可能具有挑战性。尽管肝活检仍被认为是金标准的研究工具，但在寻找新颖的非侵入性生物标志物和成像方式方面已有大量文献，旨在准确反映潜在疾病的阶段。最后，尽管目前尚无用于治疗NAFLD的疗法许可，但有一些干预措施在随机对照试验中已证明是有效的，而且针对许多驱动NAFLD的基本病理生理过程的新药的治疗方法也在不断涌现。在未来几年中，很有可能会获得具有NAFLD治疗特定许可的新治疗方法。