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Nonalcoholic Fatty Liver Disease: From Steatosis to Cirrhosis

Farrell, Geoffrey C., Larter, Claire Z.·2006·Hepatology

Abstract

Nonalcoholic steatohepatitis (NASH), the lynchpin between steatosis and cirrhosis in the spectrum of nonalcoholic fatty liver disorders (NAFLD), was barely recognized in 1981. NAFLD is now present in 17% to 33% of Americans, has a worldwide distribution, and parallels the frequency of central adiposity, obesity, insulin resistance, metabolic syndrome and type 2 diabetes. NASH could be present in one third of NAFLD cases. Age, activity of steatohepatitis, and established fibrosis predispose to cirrhosis, which has a 7- to 10-year liver-related mortality of 12% to 25%. Many cases of cryptogenic cirrhosis are likely endstage NASH. While endstage NAFLD currently accounts for 4% to 10% of liver transplants, this may soon rise. Pathogenic concepts for NAFLD/NASH must account for the strong links with overnutrition and underactivity, insulin resistance, and genetic factors. Lipotoxicity, oxidative stress, cytokines, and other proinflammatory mediators may each play a role in transition of steatosis to NASH. The present “gold standard” management of NASH is modest weight reduction, particularly correction of central obesity achieved by combining dietary measures with increased physical activity. Whether achieved by “lifestyle adjustment” or anti-obesity surgery, this improves insulin resistance and reverses steatosis, hepatocellular injury, inflammation, and fibrosis. The same potential for “unwinding” fibrotic NASH is indicated by studies of the peroxisome proliferation activator receptor (PPAR)- γ agonist “glitazones,” but these agents may improve liver disease at the expense of worsening obesity. Future challenges are to approach NAFLD as a preventive public health initiative and to motivate affected persons to adopt a healthier lifestyle. (Hepatology 2006;43:S99-S112.)

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Metadata

Authors
Farrell, G. C., & Larter, C. Z.
Venue
Hepatology
Published
2006-02
Volume
43
Issue
Supplement 1
Pages
S99-S112
ISSN
0270-9139 (ISSN-L)
OpenAlex
W2047257800
Cited by
2,414
References
23
FWCI
86.32
Type
journal article
Language
en
Open access
closed

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CoChat. (2026). Citation check: Nonalcoholic Fatty Liver Disease: From Steatosis to Cirrhosis. https://app.cochat.ai/papers/10.1002/hep.20973
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Farrell, G. C., & Larter, C. Z. (2006). Nonalcoholic Fatty Liver Disease: From Steatosis to Cirrhosis. Hepatology. https://doi.org/10.1002/hep.20973

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