Obesity, Fatty Liver and Liver Cancer

Vincent Wai-Sun Wong, Wong, Vincent Wai-Sun

Non-alcoholic fatty liver disease (NAFLD) is now the most common chronic liver disease worldwide and the second leading indication for liver transplantation and the third leading cause of hepatocellular carcinoma (HCC) in the United States. This chapter focuses on the prevention and management of NAFLD. Healthy lifestyle is the cornerstone for the prevention and management of NAFLD and should be recommended to every patient at risk or having established NAFLD. Despite the high prevalence of NAFLD, it should be recognized that the majority of patients will not develop liver-related complications; cardiovascular disease remains the leading cause of death in NAFLD patients. Until further data are available, pharmacological treatment should be restricted to selected patients with confirmed non-alcoholic steatohepatitis. As some agents with primarily anti-fibrotic effect are currently being tested in NAFLD patients, significant fibrosis and cirrhosis may become additional indications for treatment in the future. Because of the surgical morbidity, currently bariatric surgery should only be performed in patients with morbid obesity, although the long-term impact of bariatric surgery on the histology of NAFLD is favorable.