Heart and circulatory system

In parallel with the increase in prevalence of diabetes and obesity, the prevalence of nonalcoholic fatty liver disease (NAFLD) is increasing rapidly worldwide. NAFLD can be classified into two categories based on liver pathology: nonalcoholic fatty liver (NAFL) and nonalcoholic steatohepatitis (NASH). NAFL is characterized as hepatocytes with macrovesicular steatosis without ballooned hepatocytes. NASH is the clinically progressive form of NAFL, which in rare cases may culminate into cirrhosis and ultimately hepatocellular carcinoma. It is characterized by the fibrosis, hepatocytes with macrovesicular steatosis, and ballooning, in addition to lobular inflammation. There are no drugs or other therapeutics presently approved by the US Food and Drug Administration (FDA) to prevent or treat NAFLD. Thus, we discuss the role of antioxidants, cytokines, modulation of nuclear transcription factors, insulin-sensitizing agents, lipid altering agents, gastrointestinal hormones, and antifibrotic therapies to improve histological and biochemical characteristics of NAFLD. In particular, we focus the recent advances in the role of 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1) as a potential therapeutic strategy to prevent or treat NAFLD.