Introduction: Non-alcoholic fatty liver disease (NAFLD) is a socially significant health problem and it affects around a billion people on a global scale. NAFLD is the most common reason for liver damage worldwide and is considered the hepatic manifestation of the metabolic syndrome. Non-alcoholic fatty liver disease is generally associated with obesity and the related comorbidities, but it can also develop in subjects with a normal body mass index (BMI). This sub-phenotype of NAFLD is called lean NAFLD. Lean subjects with NAFLD have milder features of the metabolic syndrome when compared with obese patients. Nonetheless, they have a higher prevalence of metabolic alterations (e.g., dyslipidemia, arterial hypertension, insulin resistance, and diabetes) compared with healthy controls. The diagnosis of NAFLD requires the exclusion of both secondary causes and of a daily alcohol consumption ≥30 g for men and ≥20 g for women. Clinical Case: We present the clinical case of a 29-year-old man, who was admitted to the hospital because of diagnostic evaluation of ultrasound findings of severe liver steatosis accompanied with mild hepatosplenomegaly. There was no evidence of diabetes mellitus, hypertensive disease or obesity. The patient was overweight but without obesity: height -187 cm., weight -108 kg, BMI -30, waist circumference -111 cm. Laboratory examination revealed: normal blood count, normal level of CRP, AST, ALT, AF, total bilirubin, mild elevation of GGT and normal synthetic liver function tests. The lipid profile showed el-CLINICAL MEDICINE

Introduction: Non-alcoholic fatty liver disease (NAFLD) is a significant health problem in society and it affects around a billion people on a global scale. NAFLD is the most common reason for liver damage worldwide and is considered the hepatic manifestation of the metabolic syndrome. NAFLD could be classified into two categories: non-alcoholic fatty liver (NAFL) and non-alcoholic steatohepatitis (NASH), which can progress to liver cirrhosis.There is limited literature on the occurrence of NAFLD in pregnant women and its effect on pregnancy. It is presumed that there is an increase in the frequency of gestational diabetes, premature birth, low birth weight, preeclampsia, more frequent delivery with Caesarean section, and more frequent occurrence of intrahepatic cholestasis. There is no data on the course of pregnancy in patients with NAFLD and cirrhosis, which is already formed. Clinical case: We present the clinical case of a 30-yearold woman, who is pregnant in the VIII lunar month and was brought to the hospital due to heaviness, feeling of bloating, and swelling in the legs. Laboratory examination conducted a month before hospitalization

Background and Aim: Non-alcoholic fatty liver disease (NAFLD) is a major public health problem afflicting approximately one billion individuals worldwide. Liver biopsy is considered the gold standard for assessment of liver disease severity in patients with NAFLD. It is invasive and is associated with adverse effects, and also has higher inter-observer variability. Liver biopsy is impractical because of large number of individuals who have NAFLD and is not appropriate for screening. Therefore, non-invasive biomarkers to assess disease severity in NAFLD are needed. We use a combined approach of non-invasive imaging modalities and clinical, biochemical, metabolic and lipid biomarkers to grade liver fat and liver fibrosis, to assess presence of NAFLD, and to detect the progressive form of NAFLD, termed non-alcoholic steatohepatitis. Methods: We evaluated 60 patients with presence of metabolic syndrome and suspected NAFLD. Other liver diseases, alcohol consumption ≥20 g/day, and use of drugs associated with liver steatosis were excluded. Anthropometric variables (weight, BMI, waist circumference), liver function tests, full blood count, serum lipids, fasting glucose, abdominal ultrasonography, liver transient elastography (TE) with fibroscan M probe (XL probe only in 5%) and CAP (controlled attenuation parameter) were assessed. The cut-off values for CAP and TE were defined as previously published. Indirect markers for fibrosis and steatosis were calculated. Results: The mean age was 59 years, 59% female. 72% patients had diagnosis of diabetes mellitus (DM). The median weight was 90.3 kg, median BMI 32 kg/m² and median waist circumference -112.8 cm. According to the Hepatic Steatosis Index, 4% of the patients were without NAFLD (HSI below 30) and 92% showed HSI higher than 36. Abdominal ultrasonography findings of hepatic steatosis were: 6% with no evidence of ste-