NAFLD is gradually becoming one of the most prevalent liver diseases today, identified on imaging in 20%–33% of adults. NASH is diagnosed in 3%–16% of potential liver donors in Europe and the United States. It is also a frequent cause of cirrhosis and is projected to be the leading indication for liver transplantation in the US by 2020 [Ratziu et al. 2010; Sanyal et al. 2011]. There are two theories in the progression of NAFLD: first, that of “two hit”, involves Insulin resistance (diabetes mellitus type II, hypertriglyceridemia, hypertension, decreased HDL, obesity) by decreased sensitivity to INS and by oxidative stress, and the second, that of “multiple hit” (triggers promoting the visceral fat accumulation) which act simultaneously or successively (genetic susceptibility, epigenetic factors, physical inactivity, very high caloric intake).
The genetic factors are NASH, cirrhosis and family aggregation, with hereditary transmission of NAFLD in 39% ; ethnic factors are also very important (Hispanics but not from Cuba, Asians, North and South Americans).
Therapy is multidisciplinary, aiming on the decrease of obesity, decrease of INS resistance, and also of the oxidative stress (multi target therapy)