Open Access Open Access  Restricted Access Subscription Access
Open Access Open Access Open Access  Restricted Access Restricted Access Subscription Access

Non-Alcoholic Fatty Liver Disease


Affiliations
1 Consultant Gastroenterologist, ICON Hospital, Ahmedabad, India
     

   Subscribe/Renew Journal


NAFLD/fatty liver (> 5% fat deposition in hepatocytes) is a rapidly expanding disease entity due to the global obesity epidemic. Insulin resistance and metabolic syndrome are commonly associated with NAFLD. Upto one-third of patients affected by NAFLD have Non-Alcoholic Steatohepatitis (NASH). This subset of NAFLD decompensates and progresses to cirrhosis rapidly. Liver biopsy is the gold standard investigation to confirm NASH. Management of NAFLD is based on the clinical situation of the patient and rests on lifestyle modifications, treatment of metobolic syndrome, liver directed pharmacotherapy, bariatric surgery, and managing complications of cirrhosis.
Subscription Login to verify subscription
User
Notifications
Font Size


  • WGO Global guidelines for NAFLD/NASH.
  • Mustafa ME, Mansoor MM, Babker AM. Evaluation of Platelets Count and Coagulation parameters Among Patients With Liver Disease. World Journal of Pharmaceutical Research.2015;4(10):360-368.
  • https://www.mayoclinic.org/diseases-conditions/nonalcoholicfatty-liver-disease/symptoms-causes/syc-20354567
  • Rinella ME. Nonalcoholic fatty liver disease: a systematic review. JAMA.2015;313:2263–73.
  • Brunt EM, Wong VW, Nobili V, Day CP, Sookoian S, Maher JJ, Bugianesi E,Sirlin CB, Neuschwander-Tetri BA, Rinella ME. Nonalcoholic fatty liver disease. Nat Rev Dis Primers. 2015;1:15080.
  • Chalsani N, Younossi Z, Lavine JE, Charlton M, Cusi K, Rinella M et al. The Diagnosis and Management of Nonalcoholic Fatty Liver Disease: Practice Guidance From the American Association for the Study of Liver Diseases. HEPATOLOGY 2018;67(1).
  • Angulo P. GI epidemiology: nonalcoholic fatty liver disease.Aliment PharmacolTherapeut. 2007;25:883–889.
  • Kneeman JM, Misdraji J, Corey K. Secondary causes of nonalcoholic fatty liver disease. TherAdv Gastroenterol.2012;5(3): 199–207
  • Cobbina E, Akhlaghi F. Non-Alcoholic Fatty Liver Disease (NAFLD) - Pathogenesis, Classification, and Effect on Drug Metabolizing Enzymes and Transporters.Drug metabolism reviews. 2017;49(2):197-211.
  • Tarantino G, Finelli C. What about non-alcoholic fatty liver disease as a new criterion to definemetabolic syndrome?World J Gastroenterol. 2013; 19:3375–84.
  • Romeo S, Kozlitina J, Xing C, Pertsemlidis A, Cox D, Pennacchio LA, Boerwinkle E, Cohen JC,Hobbs HH.Genetic variation in PNPLA3 confers susceptibility to nonalcoholic fatty liver disease. Nat Genet. 2008; 40:1461– 5.
  • Sookoian S, Pirola CJ. Meta-analysis of the influence of I148M variant of patatin-like phospholipasedomain containing 3 gene (PNPLA3) on the susceptibility and histological severity ofnonalcoholic fatty liver disease.Hepatology. 2011; 53:1883–94.
  • Jou J, Choi S, Diehl A. Mechanisms of disease progression in nonalcoholic fatty liver disease. Semin Liver Dis. 2008; 28:370–9.
  • Jiang W, Wu N, Wang X, Chi Y, Zhang Y, Qiu X, Hu Y, Li J, Liu Y. Dysbiosis gut microbiotaassociated with inflammation and impaired mucosal immune function inintestine of humans with non-alcoholic fatty liver disease.Sci Rep. 2015; 5:8096.
  • Greco D, Kotronen A, Westerbacka J, Puig O, Arkkila P, Kiviluoto T, Laitinen S, Kolak M, Fisher R, Hamsten A, Auvinen P, Yki-Järvinen H. Gene expression in human NAFLD. Am J PhysiolGastrointest Liver Physiol. 2008; 294:G1281–7.
  • Fabbrini E, Magkos F, Mohammed B, Pietka T, Abumrad N, Patterson B, Okunade A, Klein S. Intrahepatic fat, not visceral fat, is linked with metabolic complications of obesity. PNAS. 2009; 106:15430–5.
  • Anderson N, Borlak J. Molecular mechanisms and therapeutic targets in steatosis and steatohepatitis. Pharmacol Rev. 2008; 60:311–57.
  • Browning J, Horton J. Molecular mediators of hepatic steatosis and liver injury. J Clin Invest. 2004; 114:147–52.
  • Sanyal A, Campbell-Sargent C, Mirshahi F, Rizzo W, Contos M, Sterling R, Luketic V, Shiffman M, Clore J.Nonalcoholic steatohepatitis: association of insulin resistance and mitochondrial abnormalities. Gastroenterology.2001; 120:1183–92.
  • Fierbinteanu-Braticevici C, Dina I, Petrisor A, Tribus L, Negreanu L, Carstoiu C. Noninvasive investigations for non alcoholic fatty liver disease and liver fibrosis. World Journal of Gastroenterology : WJG. 2010;16(38):4784-4791.
  • Adams LA, Angulo P.Role of liver biopsy and serum markers of liver fibrosis in non-alcoholic fatty liver disease.Clin Liver Dis. 2007 Feb; 11(1):25-35.
  • Oh MK, Winn J, Poordad F. Review article: diagnosis and treatment of non-alcoholic fatty liver disease. Aliment PharmacolTher. 2008;28:503–522.
  • Angulo P, Keach JC, Batts KP, Lindor KD. Independent predictors of liver fibrosis in patients with nonalcoholicsteatohepatitis.Hepatology. 1999;30:1356–1362.
  • Sanyal AJ. AGA technical review on nonalcoholic fatty liver disease. Gastroenterology. 2002;123:1705–1725.
  • European Association for the Study of the Liver (EASL), European Associationfor the Study of Diabetes (EASD), European Association for the Studyof Obesity (EASO).EASL-EASD-EASO Clinical Practice Guidelines for themanagement of non-alcoholic fatty liver disease. J Hepatol. 2016;64:1388–402.
  • Park SH, Kim PN, Kim KW, Lee SW, Yoon SE, Park SW, HaHK, Lee MG, Hwang S, Lee SG, Yu ES, Cho EY.Macrovesicularhepatic steatosis in living liver donors: use of CT for quantitativeand qualitative assessment. Radiology 2006; 239: 105-112
  • Fishbein M, Castro F, Cheruku S, Jain S, Webb B, Gleason T,Stevens WR. Hepatic MRI for fat quantitation: its relationship to fat morphology, diagnosis, and ultrasound. J ClinGastroenterol 2005; 39: 619-625
  • Fontana L, Meyer TE, Klein S, Holloszy JO. Long-term calorierestriction is highly effective in reducing the risk for atherosclerosis in humans. ProcNatlAcadSci U S A 2004;101:6659- 6663.
  • Ratziu V, Goodman Z, Sanyal A. Current efforts and trends in the treatment of NASH. J Hepatol. 2015 Apr; 62(1 Suppl):S65-75.
  • Yu JG, Javorschi S, Hevener AL, Kruszynska YT, Norman RA, Sinha M, Olefsky JM. The effect of thiazolidinediones on plasma adiponectin levels in normal, obese, and type 2 diabetic subjects.Diabetes. 2002 Oct; 51(10):2968-74.
  • Sanyal AJ, Chalasani N, Kowdley KV, McCullough A, Diehl AM, Bass NM, Neuschwander-Tetri BA, Lavine JE, Tonascia J, Unalp A, Van Natta M, Clark J, Brunt EM, Kleiner DE, Hoofnagle JH, Robuck PR, NASH CRN.Pioglitazone, vitamin E, or placebo for nonalcoholic steatohepatitis. N Engl J Med. 2010 May 6; 362(18):1675-85.
  • Ratziu V, Goodman Z, Sanyal A. Current efforts and trends in the treatment of NASH. J Hepatol. 2015 Apr; 62(1 Suppl):S65-75.
  • Soden JS, Devereaux MW, Haas JE, Gumpricht E, Dahl R, Gralla J, Traber MG, Sokol RJ. Subcutaneous vitamin E ameliorates liver injury in an in vivo model of steatocholestasis. Hepatology. 2007 Aug; 46(2):485-95.
  • Dyson JK, Anstee QM, McPherson S. Republished: Nonalcoholic fatty liver disease: a practical approach to treatment.Postgrad Med J. 2015 Feb; 91(1072):92-101.
  • Rinella ME, Sanyal AJ. NAFLD in 2014: Genetics, diagnostics and therapeutic advances in NAFLD.Nat RevGastroenterolHepatol. 2015 Feb; 12(2):65-6.
  • Neuschwander-Tetri BA, Loomba R, Sanyal AJ, Lavine JE, Van Natta ML, Abdelmalek MF, Chalasani N, Dasarathy S, Diehl AM, Hameed B, Kowdley KV, McCullough A, Terrault N, Clark JM, Tonascia J, Brunt EM, Kleiner DE, Doo E, NASH Clinical Research Network.Farnesoid X nuclear receptor ligand obeticholic acid for non-cirrhotic, non-alcoholic steatohepatitis (FLINT): a multicentre, randomised, placebo-controlled trial.Lancet. 2015 Mar 14; 385(9972):956-65.
  • Hirata T, Tomita K, Kawai T, Yokoyama H, Shimada A, Kikuchi M, Hirose H, Ebinuma H, Irie J, Ojiro K, Oikawa Y, Saito H, Itoh H, Hibi T. Effect of Telmisartan or Losartan for Treatment of Nonalcoholic Fatty Liver Disease: Fatty Liver Protection Trial by Telmisartan or Losartan Study (FANTASY).Int J Endocrinol. 2013; 2013():587140.
  • Munteanu MA, Mircea PA. From NAFLD toCardiovascular Disease. Is it (Still) the Metabolic Syndrome?Clujul Med. 2014; 87(2):80-6
  • Schauer PR, Kashyap SR, Wolski K, Brethauer SA, Kirwan JP, Pothier CE, et al. Bariatric surgery versus intensive medical therapy in obese patients with diabetes.N Engl J Med. 2012; 336(17):1567-76.
  • Schauer PR, Bhatt DL, Kirwan JP, Wolski K, Brethauer SA, Navaneethan SD, et al. Bariatric surgery versus intensive medical therapy for diabetes 3-year outcomes. N Engl J Med. 2014; 370(21):2002-13.
  • Lisboa QC, Costa SM, Couto CA. Current management of non-alcoholic fatty liver disease. Rev Assoc Med Bras 2016; 62(9):872-878.
  • Musso G, Gambino R, Cassader M, Pagano G. A metaanalysis of randomizedtrials for the treatment of nonalcoholic fatty liver disease. Hepatology. 2010; 52(1):79-104.
  • Zeng T, Zhang CL, Zhao XL, Xie KQ. Pentoxifylline for the treatment ofnonalcoholic fatty liver disease: a metaanalysis of randomized double-blind, placebo-controlled studies. Eur J GastroenterolHepatol. 2014; 26(6):646-53.
  • Brown JD, Plutzky J. Peroxisome proliferator-activated receptors astranscriptional nodal points and therapeutic targets. Circulation. 2007; 115(4):518-33.
  • Stienstra R, Mandard S, Patsouris D, Maass C, Kersten S, Müller M.Peroxisome proliferator-activated receptor protects against obesity-induced hepatic inflammation. Endocrinology. 2007; 148(6):2753-63.
  • Parker HM, Johnson NA, Burdon CA, Cohn JS, O’Connor HT, George J.Omega-3 supplementation and non-alcoholic fatty liver disease: a systematic review and metaanalysis.

Abstract Views: 201

PDF Views: 0




  • Non-Alcoholic Fatty Liver Disease

Abstract Views: 201  |  PDF Views: 0

Authors

Manish S. Bhatnagar
Consultant Gastroenterologist, ICON Hospital, Ahmedabad, India

Abstract


NAFLD/fatty liver (> 5% fat deposition in hepatocytes) is a rapidly expanding disease entity due to the global obesity epidemic. Insulin resistance and metabolic syndrome are commonly associated with NAFLD. Upto one-third of patients affected by NAFLD have Non-Alcoholic Steatohepatitis (NASH). This subset of NAFLD decompensates and progresses to cirrhosis rapidly. Liver biopsy is the gold standard investigation to confirm NASH. Management of NAFLD is based on the clinical situation of the patient and rests on lifestyle modifications, treatment of metobolic syndrome, liver directed pharmacotherapy, bariatric surgery, and managing complications of cirrhosis.

References