It is also very common in developed nations, such as the United States, and affected about 75 to 100 million Americans in 2017. This type of program also leads to improvements in NAFLD measured using blood tests, ultrasound, imaging, or liver biopsies. Percutaneous liver biopsy remains the most common practice. Since both effectively reduce liver fat, a pragmatic approach to the choice of physical activity that accounts for the individual's preferences for what they can maintain in the long-term is preferred. , Surgery carries more risks for individuals with NASH cirrhosis, with a review estimating overall morbidity to be 21%. Non-alcoholic beer is available to people who drive. , Insulin sensitizers (metformin and thiazolidinediones, such as pioglitazone) and liraglutide are not specifically recommended for NAFLD as they do not directly improve the liver condition. Non-alcoholic fatty liver disease (NAFLD), also known as metabolic (dysfunction) associated fatty liver disease (MAFLD), is excessive fat build-up in the liver without another clear cause such as alcohol use. , Bariatric surgery is an effective method for obese and diabetic individuals with NAFLD to induce weight loss and reduce or resolve NASH inflammation, including fibrosis, and improve longevity.  An international study showed that people with NAFLD had a 10‐year survival rate of 81.5%.  Obesity predicts a worse long-term outcome than for lean individuals.  People with NAFLD can benefit from a moderate to low-carbohydrate diet and a low-fat diet. , NAFLD is strongly associated with or caused by type 2 diabetes, insulin resistance, and metabolic syndrome (defined as at least three of the five following medical conditions: abdominal obesity, high blood pressure, high blood sugar, high serum triglycerides, and low serum high-density lipoprotein). , NAFLD incidence is rapidly rising, along with obesity and diabetes, and has become the most common cause of liver disease in developed countries, for adults, teenagers, and children. , Herbal compounds such as silymarin (a milk thistle seed extract), curcumin, a turmeric extract, and green tea appear to improve NAFLD biomarkers and reduce the grade of NAFLD. ヒトにみられる非アルコール性脂肪性肝疾患（ non-alcoholic fatty liver disease, NAFLD）、特に非アルコール性脂肪性肝炎（non-alcoholic steatohepatitis, NASH）の予防・改善に有効であり、安全性が高く、しかも、カフェインを含まず、経口摂取しやすいNAFLDの予防および／または治療に有用な、経口摂取用組成物を提供する。 , Non-alcoholic and alcoholic fatty liver disease share similar histological features, which suggests that they might share common pathogenic pathways. Thus, people suffering from NAFLD deserve consideration for treatment regardless of the presence or absence of obesity.  Studies in experimental animals implicated choline inadequacy in the 1920s in the 1920s and excess sugar consumption in 1949. Stages of non-alcoholic fatty liver disease, progressing from healthy, to steatosis (fat accumulation), inflammation, fibrosis and cirrhosis. , Omega-3 fatty acids may reduce liver fat and improve blood lipid profile but do not seem to improve liver histology (fibrosis, cirrhosis, cancer).  A further nutrigenomics model named multiple hit extends the second hit model, suggesting that multiple disease biomarkers and factors such as genes and nutrition influence NAFLD and NASH progression. , There is no special treatment for liver cancer associated with NAFLD/NASH and are treated according to general guidelines on liver cancers.  Although NAFLD can cause cirrhosis and liver failure and liver cancer, most deaths among people with NAFLD are attributable to cardiovascular disease. , A liver ultrasound scan or magnetic resonance imaging (MRI) can diagnose steatosis, but not fibrosis and confirmation of early cirrhosis detection by ultrasound by other diagnostic methods is recommended.  These FFAs are combined back into triglycerides in the liver, forming the major constituent of the accumulated fat in the liver. , NAFLD comprises two histological categories: NAFL, and the more aggressive form NASH.  NAFLD is associated with metabolic syndrome, which is a cluster of risk factors that contribute to the development of cardiovascular disease and type 2 diabetes mellitus. Conditions most frequently found in association with nonalcoholic fatty liver disease include obesity, Type 2 diabetes, and hyperlipidemia. , Although blood tests cannot diagnose NAFLD, circulating serum biomarkers of liver fibrosis can give moderate estimates in the diagnosis of liver fibrosis and cirrhosis.  NASH increases hepatocyte death via apoptosis or necroptosis is increased in NASH compared with simple steatosis, and inflammation is a hallmark of NASH. It is also associated with hormonal disorders (panhypopituitarism, hypothyroidism, hypogonadism, polycystic ovary syndrome), persistently elevated transaminases, increasing age and hypoxia caused by obstructive sleep apnea, with some of these conditions predicting disease progression. People with NAFLD are not at higher risk for serious liver injury from statins, according to AASLD and EASL. Chiang H, Lu HF, Chen JC, et al.  MRE possesses a good sensitivity to quantify hepatic fat and excellent accuracy to detect fibrosis in NAFLD regardless of BMI and inflammation and is suggested as a more reliable alternative to diagnose NAFLD and its progression to NASH compared to ultrasound and blood tests.  Exercise alone can prevent or reduce hepatic steatosis, but it remains unknown whether it can improve all other aspects of the liver; hence a combined approach with diet and exercise is advised.  Preoperative weight loss can reduce operative time and hospital stay, although there is insufficient evidence whether preoperative weight loss reduces long-term morbidity or complications.  The mean age is usually above 10 years, as children can also report non-specific symptoms and are thus difficult to diagnose for NAFLD.  The broader NAFLD term started to be used around 2002. Vital signs must be monitored frequently afterward (at least every 15 minutes in the hour following the biopsy).  Indeed, some individuals might develop new or worsened features of NAFLD.  Treatment with pentoxifylline is not recommended. The presence of metabolic syndrome, NAFLD Fibrosis Score (FIB-4), or liver stiffness (as measured by Vibration-controlled transient elastography or MRE) can identify the individuals who are at higher risk of steatohepatitis or advanced fibrosis. As the name implies, the main characteristic of NAFLD is too much fat stored in liver cells.NAFLD is increasingly common around the world, especially in Western nations.  Other risks include being overweight, metabolic syndrome (defined as at least three of the five following medical conditions: abdominal obesity, high blood pressure, high blood sugar, high serum triglycerides, and low serum HDL cholesterol), a diet high in fructose, and older age.  Instead, alteration of the profile of the other lipid subtypes present in the liver, such as diacylglycerols, phospholipids, ceramides, and free cholesterol, have a more significant role in the pathogenesis of NAFLD.  Higher levels of intestinal bacteria that produce butyrate may be protective.