Editing Hepatitis (section)

==== Non-alcoholic fatty liver disease ====
{{Main|Non-alcoholic fatty liver disease}}

Non-alcoholic hepatitis is within the spectrum of non-alcoholic liver disease (NALD), which ranges in severity and reversibility from [[non-alcoholic fatty liver disease]] (NAFLD) to non-alcoholic steatohepatitis (NASH) to cirrhosis to liver cancer, similar to the spectrum of alcoholic liver disease.<ref name="Harrison's Principles chapter 364 (Nonalcoholic)">{{Cite book|title=Harrison's Principles of Internal Medicine 19e|author1=Abdelmalek, MF |author2=Diehl AM |publisher=McGraw-Hill|year=2015|isbn=978-0-07-180215-4|editor1=Kasper, D |editor2=Fauci, A |editor3=Hauser, S |editor4=Longo, D |editor5=Jameson, J |editor6=Loscalzo, J |chapter=Chapter 364: Nonalcoholic Liver Diseases and Nonalcoholic Steatohepatitis}}</ref>

Non-alcoholic liver disease occurs in people with little or no history of alcohol use, and is instead strongly associated with [[metabolic syndrome]], obesity, [[insulin resistance]] and [[Diabetes mellitus type 2|diabetes]], and hypertriglyceridemia.<ref name="Friedman 55e" /> Over time, non-alcoholic fatty liver disease can progress to non-alcoholic [[steatohepatitis]], which additionally involves liver cell death, liver inflammation and possible fibrosis.<ref name="Friedman 55e" /> Factors accelerating progression from NAFLD to NASH are obesity, older age, non-African American ethnicity, female gender, diabetes mellitus, hypertension, higher [[Alanine transaminase|ALT]] or [[Aspartate transaminase|AST]] level, higher AST/ALT ratio, low platelet count, and an ultrasound steatosis score.<ref name="Friedman 55e" />

In the early stages (as with NAFLD and early NASH), most patients are asymptomatic or have mild [[Quadrant (abdomen)|right upper quadrant]] pain, and diagnosis is suspected on the basis of abnormal [[liver function tests]].<ref name="Friedman 55e" /> As the disease progresses, symptoms typical of chronic hepatitis may develop.<ref name="National Digestive Diseases Information Clearinghouse NDDIC">{{cite web|url=http://digestive.niddk.nih.gov/ddiseases/pubs/nash/index.aspx|title=Nonalcoholic Steatohepatitis|publisher=National Digestive Diseases Information Clearinghouse (NDDIC)|access-date=27 November 2013|author=National Digestive Diseases Information Clearinghouse (NDDIC)|url-status=live|archive-url=https://web.archive.org/web/20131202231555/http://digestive.niddk.nih.gov/ddiseases/pubs/nash/index.aspx|archive-date=2 December 2013}}</ref> While imaging can show fatty liver, only [[liver biopsy]] can demonstrate inflammation and fibrosis characteristic of NASH.<ref name="Masuoka 2013 106–122">{{cite journal|last=Masuoka|first=Howard C.|author2=Chalasani, Naga|title=Nonalcoholic fatty liver disease: an emerging threat to obese and diabetic individuals|journal=Annals of the New York Academy of Sciences|date=April 2013|volume=1281|issue=1|pages=106–122|doi=10.1111/nyas.12016|bibcode=2013NYASA1281..106M|pmid=23363012|pmc=3646408}}</ref> 9 to 25% of patients with NASH develop cirrhosis.<ref name="Friedman 55e" /> NASH is recognized as the third most common cause of liver disease in the United States.<ref name="National Digestive Diseases Information Clearinghouse NDDIC" />