Diagnostic and therapeutic challenges in Non-Alcoholic Fatty Liver Disease (NAFLD)

Non-Alcoholic Fatty Liver Disease (NAFLD) has become one of the most common chronic liver diseases worldwide, impacting around 25% of the global population. NAFLD describes a range of liver disease from simple steatosis to non-alcoholic steatohepatitis (NASH), progressive fibrosis, cirrhosis, and hepatocellular carcinoma. The rising prevalence of NAFLD closely resembles the global increase in obesity, insulin resistance, type 2 diabetes mellitus and metabolic syndrome. Given how common NAFLD is, it is underdiagnosed and undertreated because individuals that are affected by it experience few to no symptoms until the disease is advanced and there are no accurate non-invasive diagnostic tools to assist providers. The diagnosis of NAFLD involves a complimentary clinical assessment and methods such as imaging, biochemical markers, and histological confirmation. However, none of these modalities offer a holistic, accurate, and reproducible way to stage the severity of liver disease and this varies for individuals with similar metabolic profiles and chronic liver disease. This variability makes it challenging to stratify an individual's risk and predict a prognosis. The treatment of NAFLD is based on lifestyle changes, specifically weight loss by dietary changes and increased physical activity for all individuals. Multiple pharmacologic agents have demonstrated efficacy in clinical trials, Food and Drug Administration (FDA) specifically for the treatment of NAFLD or NASH. This study aims to provide a critical overview of the current focus of NAFLD diagnosis and management, and highlight the issues confronting clinicians and researchers. This overview looks at emerging biomarkers, evolving imaging modalities, and investigations into novel therapeutic strategies. Optimal care for patients with NAFLD requires a multidisciplinary approach which integrates the practices of early diagnosis and screening, targeted therapy including lifestyle recommendations, and long-term follow-up.