JOURNAL OF INSURANCE MEDICINE Copyright Q 2004 Journal of Insurance Medicine J Insur Med 2004;36:27±41 REVIEW Nonalcoholic Fatty Liver Disease (NAFLD): A Comprehensive Review William B. Salt II, MD Nonalcoholic fatty liver disease (NAFLD) is de®ned as fatty in®ltra- Address: The Ohio State University, tion of the liver exceeding 5% to 10% by weight. It is a spectrum of Columbus, Ohio; e-mail: disorders ranging from simple fatty liver (steatosis without liver in-
[email protected]. jury), nonalcoholic steatohepatitis (steatosis with in¯ammation), and Correspondent: William B. Salt II, ®brosis/cirrhosis that resembles alcohol-induced liver disease but MD; Ohio Gastroenterology Group, which develops in individuals who are not heavy drinkers. NAFLD Clinical Associate Professor in Med- is likely the most common cause of chronic liver disease in many icine. countries. NAFLD may also potentiate liver damage induced by oth- er agents, such as alcohol, industrial toxins and hepatatrophic vi- Key words: Nonalcoholic fatty liver ruses. disease (NAFLD), nonalcoholic stea- The lack of speci®c and sensitive noninvasive tests for NAFLD tohepatitis (NASH), insulin resis- limits reliable detection of the disease. It is often diagnosed on a tance syndrome, liver transaminas- presumptive basis when liver enzyme elevations are noted in over- es, liver biopsy, life insurance. weight or obese individuals without identi®able etiology for liver disease, or when imaging studies suggest hepatic steatosis. NAFLD is now considered to be a component of the insulin re- sistance syndrome (metabolic syndrome X). Controversy exists rel- ative to optimal recognition, diagnosis and management of these conditions, and treatment recommendations are evolving.