Nonalcoholic Fatty Liver Disease

Mariana Lazo, M.D., Jeanne Clark, M.D.
Nonalcoholic Fatty Liver Disease is a topic covered in the Johns Hopkins Diabetes Guide.

To view the entire topic, please or purchase a subscription.

Official website of the Johns Hopkins Antibiotic (ABX), HIV, Diabetes, and Psychiatry Guides, powered by Unbound Medicine. Johns Hopkins Guide App for iOS, iPhone, iPad, and Android included. Explore these free sample topics:

Johns Hopkins Guides

-- The first section of this topic is shown below --


  • Nonalcoholic fatty liver disease (NAFLD): fatty infiltration (steatosis) of the liver, exceeding 5% of liver weight. In biopsy specimens, >5-10% macrosteatotic hepatocytes.
    • By definition, requires exclusion of alcohol as a potential cause. Acceptable levels of alcohol consumption are controversial but in general < 20 grams/day (2 drinks) in men and < 10 grams/day (1 drink) in women are considered safe, and below the cutoff associated with increased risk of cirrhosis (30 grams/day in men and 20 grams/day in women).
  • Primary NAFLD: common term for typical NAFLD associated with central obesity and/or type 2 diabetes (T2DM) or insulin resistance (IR), without another specific etiology.
  • Secondary NAFLD: used to defined as NAFLD in the absence of insulin resistance and associated with other causes such as: polycystic ovary syndrome, hypothyroidism, hypogonadism, hypopituitarism, medication use (glucocorticoids, tamoxifen, amiodarone, HAART, diltiazem), disorders of lipid metabolism (abetalipoproteinemia, lipodystrophy, Weber-Christian syndrome, Andersen’s disease), total parenteral nutrition and jejunoileal bypass surgery. Many cases of "secondary" NAFLD likely represent an exacerbation of often unrecognized "primary" NAFLD.
  • Nonalcoholic steatohepatitis (NASH): the more severe form of NAFLD characterized by inflammation, hepatocyte injury (ballooned hepatocytes), with or without fibrosis. It can progress to cirrhosis and possibly liver cancer.
  • NASH cirrhosis: the presence of cirrhosis with current or previous evidence of steatosis or NASH.
  • Cryptogenic cirrhosis: a term used to define the presence of cirrhosis with no obvious etiology, however, frequently there is a history of diabetes and obesity.

-- To view the remaining sections of this topic, please or purchase a subscription --

Last updated: June 27, 2015