NAFLD 2020: The State of the Disease

Abstract Nonalcoholic fatty liver disease (NAFLD) is the most common liver disease with a worldwide prevalence of 25%. In the US, NAFLD and its subtype, nonalcoholic steatohepatitis (NASH), affect 30% and 5% of the population, respectively. Considering the ongoing obesity epidemic beginning in childhood, the rise in Diabetes and other factors, the prevalence of NAFLD along with the proportion of those with advanced liver disease is projected to continue to increase. This will have an important impact on public health reflected in healthcare costs, including impact on the need for liver transplantation, for which NASH is already close to becoming the most common indication. NAFLD patients with evidence of NASH and advanced fibrosis are at markedly increased risk of adverse outcomes including overall mortality, and liver-specific morbidity and mortality, respectively. Identification of this cohort of NAFLD patients is paramount given the associated poorer outcomes in order to target resources to those who need it most. Various non-invasive tools have been developed in this regard. This review provides an update on the epidemiology, clinical and prognostic features and diagnostic approach to patients with NAFLD.