Volume 10 ; Issue 2 ; in Month : July-Dec (2026) Article No : 208
Kumar A, Ranjan S, Kumar M, et al.

Abstract

Non-alcoholic fatty liver disease (NAFLD) has emerged as a rapidly escalating global health crisis and the primary hepatic manifestation of metabolic syndrome. The disease is intimately linked to the worldwide epidemics of obesity, severe insulin resistance, and type 2 diabetes mellitus. This comprehensive review explores the dynamic clinical spectrum of NAFLD. It details the pathological progression from simple, asymptomatic fat accumulation (steatosis) to aggressive non-alcoholic steatohepatitis (NASH), advanced fibrosis, and irreversible liver cirrhosis. Epidemiological trends indicate an alarming rise in global and regional prevalence, placing a massive burden on the Indian healthcare system. The unique Indian demographic profile, characterized by a high incidence of "lean NAFLD" and rapid rural-urban dietary shifts, presents distinct diagnostic challenges. The complex pathogenesis is best explained by the "multiple-hit hypothesis," which illustrates how lifestyle drivers, genetic susceptibility, severe lipotoxicity, and gut microbiome dysbiosis simultaneously destroy hepatic architecture. Furthermore, this study examines the heavily under-researched, bidirectional link between systemic neuroinflammation, psychotropic medications, and accelerated metabolic liver damage. Despite the massive clinical burden, a significant therapeutic gap remains. There are currently no universally approved, targeted pharmacological treatments specifically for NAFLD or NASH. Consequently, disease management depends heavily on sustained lifestyle modifications, including strict dietary control and regular physical activity. Pharmacological interventions are primarily limited to off-label prescribing aimed at controlling co-existing cardiovascular and metabolic risks. Ultimately, this study highlights the urgent clinical necessity for novel drug discovery in hepatology. It strongly emphasizes the indispensable role of pharmacy professionals within a multi-disciplinary healthcare team. Pharmacists remain critical in managing complex polypharmacy, mitigating drug-induced metabolic side effects, and ensuring safe, comprehensive care for patients navigating this aggressive, silent epidemic.

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