Genetics and epigenetics in the clinic: Precision medicine in the management of fatty liver disease

This narrative review will discuss the current evidence supporting the possible application of precision or personalized medicine to the management of nonalcoholic or “metabolic” fatty liver disease (NAFLD), based on recent progress in the understanding of the genetics and epigenetics of the disease. The prevalence of NAFLD, which can progress to cirrhosis and hepatocellular carcinoma, is constantly increasing worldwide. Accurate non-invasive predictors of liver disease progression, as well as of cardiovascular complications of NAFLD, are ur-gently needed. Evidence is now reporting that the genetic and epigenetic factors involved in NAFLD develop-ment can be used to develop risk scores for liver-related complications, which may show the possibility to im-plement programs for targeted screening and surveillance of complications. Moreover, genetic and epigenetic factors identifying specific sub-phenotypes of NAFLD can predict the individual response to pharmacological therapies. Finally, we describe opportunities for gene-targeted therapeutic approaches in NAFLD, where the genetic variants represent therapeutic targets for precision therapy approaches.