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Dr Shalini Jaggi, New Delhi 16 December 2022

One in five individuals globally are estimated to have nonalcoholic fatty liver disease (NAFLD).
Its prevalence is strongly associated with obesity and metabolic disorders; however, evidence is mounting occurrence among nonobese individuals.
Whilst bland steatosis itself is not harmful, it lays the foundation for the development of nonalcoholic steatohepatitis (NASH) and hepatocellular carcinoma (HCC).
The complex and heterogeneous nature of NAFLD challenges the quest to find the holy grail of treatments.
So far treatments are generally aimed at directly ameliorating either one of the hallmark characteristics driving NAFLD (steatosis, inflammation and fibrosis) or the gut microbiome.
The NAFLD treatment landscape is rapidly evolving as a consequence of our growing understanding of its underpinning mechanisms.
Treatments aimed at ameliorating not one, but multiple, features of the condition hold great promise.
Several treatments have been tested in clinical trials, and whilst some promising results have been obtained, most have failed to deliver the desired outcome.
Increasing appreciation of the heterogeneity of NAFLD will enable us to develop more personalized therapies. Whilst the holy grail has not yet been found; step by step, its quest is ongoing and getting closer to the discovery of successful NAFLD treatments.

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