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S porastom incidencije debljine i metaboličkog sindroma raste i incidencija nealkoholne masne bolesti jetre (engl. nonalcoholic fatty liver disease – NAFLD). Osim što ovi bolesnici imaju znatan rizik od progresije u terminalni stadij kronične bolesti jetre, poznato je da imaju i povećan rizik od razvoja hepatocelularnog karcinoma. S druge strane, posljednjih godina sve je veći broj publikacija koje govore u prilog tomu da NAFLD nije samo bolest ograničena na jetru, nego je udružena s nizom izvanjetrenih bolesti i stanja, a najčešće s kardiovaskularnim bolestima, kroničnom bubrežnom bolesti i šećernom bolesti tipa II. Posljedično, NAFLD je postao rastući javnozdravstveni problem. Brojni supspecijalisti, kao i liječnici obiteljske medicine trebali bi biti svjesni navedenih potencijalnih izvanjetrenih manifestacija NAFLD-a s obzirom na dostupnost brojnih metoda za probir u kliničkoj praksi. Navedeno je važno kako bi se potencijalne izvanjetrene manifestacije NAFLD-a detektirale u ranim stadijima, a time i prevenirala ili barem usporila progresija pojedinih bolesti., With the increasing incidence of obesity and metabolic syndrome the incidence of nonalcoholic fatty liver ­disease (NAFLD) is increasing as well. These patients have a significant risk of progression to the end-stage liver disease, but also these patients are at increased risk of developing hepatocellular carcinoma. In recent years there is a growing ­number of publications that support the idea that NAFLD is not just a disease that is limited to the liver, but is associated with a number of extrahepatic manifestations. For example, NAFLD increases the risk of type 2 diabetes mellitus, cardiovascular diseases and chronic kidney disease. Consequently NAFLD has become a growing public health problem. A number of sub-specialists as well as primary care physicians should be aware of these potential extrahepatic associations, given the availability of numerous methods for screening in clinical practice. The above approach is important in order to recognize potentially modifiable events in the early stages, and thus manage them and at least prevent the progression of certain diseases.

Nealkoholna masna bolest jetre (engl. nonalcoholic fatty liver disease – NAFLD) čest je uzrok aletiranih jetrenih parametara. Povezanost između masne jetre i metaboličkog sindroma (MS) dobro je dokumentirana i široko prihvaćena. Ciroza kao posljedica nealkoholnog steatohepatitisa (NASH) trenutačno je druga najčešća indikacija za liječenje transplantacijom jetre u SAD-u, a pretpostavlja se da će do 2030. postati i glavnom indikacijom za transplantaciju jetre. Gastroenterolozi/hepatolozi, kao i liječnici obiteljske medicine imaju više pitanja nego odgovora kada je u pitanju NAFLD. Najčešća su pitanja koji bolesnici s NAFLD-om imaju rizik od progresije u NASH, fi brozu, cirozu jetre i hepatocelularni karcinom te kojim bolesnicima s NAFLD-om trebamo učiniti biopsiju jetre. Osim toga sve je više neinvazivnih dijagnostičkih metoda u pristupu bolesniku s NAFLD-om. Kako pristupiti ovim bolesnicima u svakodnevnoj kliničkoj praksi postalo je više umjetnost nego znanost u ovom trenutku. U ovome preglednom radu pokušat ćemo pružiti recentne preporuke kako pristupiti bolesniku s NAFLD-o, Nonalcoholic fatty liver disease (NAFLD) has become a common cause of elevated liver tests. The association between fatty liver and metabolic syndrome (MS) is well documented and widely accepted. Cirrhosis due to nonalcoholic steatohepatitis (NASH) is currently the second most common indication for liver transplant with increasing incidence. Gastroenterologists/hepathologists and primary care physicians have more questions than answers regarding the NAFLD. The most common questions are which NAFLD patients have a risk of progression to NASH, fi brosis, cirrhosis and hepatocellular carcinoma, and which patients with NAFLD have a need for liver biopsy. In addition, a number of non-invasive diagnostic methods in the approach to the patient with NAFLD are investigated. How to approach these patients in routine clinical practice, is more of an art than a science at this time. In this article we will try to provide more recent recommendations of how to approach the patients with NAFLD

S porastom incidencije debljine i metaboličkog sindroma raste i incidencija nealkoholne masne bolesti jetre (engl. nonalcoholic fatty liver disease – NAFLD). Osim što ovi bolesnici imaju znatan rizik od progresije u terminalni stadij kronične bolesti jetre, poznato je da imaju i povećan rizik od razvoja hepatocelularnog karcinoma. S druge strane, posljednjih godina sve je veći broj publikacija koje govore u prilog tomu da NAFLD nije samo bolest ograničena na jetru, nego je udružena s nizom izvanjetrenih bolesti i stanja, a najčešće s kardiovaskularnim bolestima, kroničnom bubrežnom bolesti i šećernom bolesti tipa II. Posljedično, NAFLD je postao rastući javnozdravstveni problem. Brojni supspecijalisti, kao i liječnici obiteljske medicine trebali bi biti svjesni navedenih potencijalnih izvanjetrenih manifestacija NAFLD-a s obzirom na dostupnost brojnih metoda za probir u kliničkoj praksi. Navedeno je važno kako bi se potencijalne izvanjetrene manifestacije NAFLD-a detektirale u ranim stadijima, a time i prevenirala ili barem usporila progresija pojedinih bolesti., With the increasing incidence of obesity and metabolic syndrome the incidence of nonalcoholic fatty liver ­disease (NAFLD) is increasing as well. These patients have a significant risk of progression to the end-stage liver disease, but also these patients are at increased risk of developing hepatocellular carcinoma. In recent years there is a growing ­number of publications that support the idea that NAFLD is not just a disease that is limited to the liver, but is associated with a number of extrahepatic manifestations. For example, NAFLD increases the risk of type 2 diabetes mellitus, cardiovascular diseases and chronic kidney disease. Consequently NAFLD has become a growing public health problem. A number of sub-specialists as well as primary care physicians should be aware of these potential extrahepatic associations, given the availability of numerous methods for screening in clinical practice. The above approach is important in order to recognize potentially modifiable events in the early stages, and thus manage them and at least prevent the progression of certain diseases.