Non-alcoholic fatty liver disease and steatohepatitis

2013 ◽  
Vol 154 (29) ◽  
pp. 1124-1134
Author(s):  
Gabriella Pár ◽  
Gábor Horváth ◽  
Alajos Pár
Keyword(s):  
Metabolic Syndrome ◽  
Liver Disease ◽  
Fatty Liver ◽  
Fatty Liver Disease ◽  
Treatment Modalities ◽  
High Dose ◽  
Alcoholic Fatty Liver ◽  
Alcoholic Steatohepatitis ◽  
Increased Risk ◽  
Alcoholic Fatty Liver Disease

Non-alcoholic fatty liver disease and non-alcoholic steatohepatitis, the hepatic manifestations of metabolic syndrome with close association with inzulin resistance and obesity, are the most common liver diseases, affecting up to a third of the population worldwide. They confer increased risk for hepatocellular carcinoma as well as cardiovascular diseases. The review aims to summarize advances in epidemiology, pathogenesis and clinical management of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis. Besides liver biopsy and biomarkers, a novel non-invasive diagnostic tool the called “controlled attenuation parameter” measuring the attenuation of ultrasound generated by the transient elastography transducer, can quantitatively assess the hepatic fat content and differentiate between steatosis grades. At the same time, liver stiffness (fibrosis) can also be evaluated. The authors present their own results obtained with the latter procedure. In non-alcoholic fatty liver disease, the lifestyle intervention, weight loss, diet and exercise supported by cognitive behavioural therapy represent the basis of management. Components of metabolic syndrome (obesity, dyslipidaemia, diabetes and arterial hypertension) have to be treated. Although there is no approved pharmacological therapy for NASH, it seems that long lasting administration of vitamin E in association with high dose ursodeoxycholic acid may be beneficial. In addition, omega-3 polyunsaturated fatty acid substitution can also decrease liver fat, however, the optimal dose is not known yet. Further controlled clinical studies are warranted to establish the real value of any suggested treatment modalities for non-alcoholic fatty liver disease and non-alcoholic steatohepatitis, although these are in experimental phase yet. Orv. Hetil., 2013, 154, 1124–1134.

scholarly journals Non-alcoholic fatty liver disease: the hepatic consequence of obesity and the metabolic syndrome

2010 ◽  
Vol 69 (2) ◽  
pp. 211-220 ◽  
Author(s):  
J. Bernadette Moore
Keyword(s):  
Metabolic Syndrome ◽  
Liver Disease ◽  
Fatty Liver ◽  
Fatty Liver Disease ◽  
Response To Treatment ◽  
Health Concern ◽  
Alcoholic Fatty Liver ◽  
The Metabolic Syndrome ◽  
Increased Risk ◽  
Alcoholic Fatty Liver Disease

Non-alcoholic fatty liver disease (NAFLD) is now the most common liver disease in both adults and children worldwide. As a disease spectrum, NAFLD may progress from simple steatosis to steatohepatitis, advanced fibrosis and cirrhosis. An estimated 20–35% of the general population has steatosis, 10% of whom will develop the more progressive non-alcoholic steatohepatitis associated with markedly increased risk of cardiovascular- and liver-related mortality. Development of NAFLD is strongly linked to components of the metabolic syndrome including obesity, insulin resistance, dyslipidaemia and type 2 diabetes. The recognition that NAFLD is an independent risk factor for CVD is a major public health concern. There is a great need for a sensitive non-invasive test for the early detection and assessment of the stage of NAFLD that could also be used to monitor response to treatment. The cellular and molecular aetiology of NAFLD is multi-factorial; genetic polymorphisms influencing NAFLD have been identified and nutrition is a modifiable environmental factor influencing NAFLD progression. Weight loss through diet and exercise is the primary recommendation in the clinical management of NAFLD. The application of systems biology to the identification of NAFLD biomarkers and factors involved in NAFLD progression is an area of promising research.

scholarly journals Cardiovascular Risk in Non-Alcoholic Fatty Liver Disease: Mechanisms and Therapeutic Implications

2019 ◽  
Vol 16 (17) ◽  
pp. 3104 ◽  
Author(s):  
Claudio Tana ◽  
Stefano Ballestri ◽  
Fabrizio Ricci ◽  
Angelo Di Vincenzo ◽  
Andrea Ticinesi ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Cardiovascular Risk ◽  
Liver Disease ◽  
Fatty Liver ◽  
Fatty Liver Disease ◽  
Cardiovascular Events ◽  
Alcoholic Fatty Liver ◽  
The Metabolic Syndrome ◽  
Increased Risk ◽  
Alcoholic Fatty Liver Disease

New evidence suggests that non-alcoholic fatty liver disease (NAFLD) has a strong multifaceted relationship with diabetes and metabolic syndrome, and is associated with increased risk of cardiovascular events, regardless of traditional risk factors, such as hypertension, diabetes, dyslipidemia, and obesity. Given the pandemic-level rise of NAFLD—in parallel with the increasing prevalence of obesity and other components of the metabolic syndrome—and its association with poor cardiovascular outcomes, the question of how to manage NAFLD properly, in order to reduce the burden of associated incident cardiovascular events, is both timely and highly relevant. This review aims to summarize the current knowledge of the association between NAFLD and cardiovascular disease, and also to discuss possible clinical strategies for cardiovascular risk assessment, as well as the spectrum of available therapeutic strategies for the prevention and treatment of NAFLD and its downstream events.

scholarly journals Non alcoholic fatty liver disease is a predictor of subclinical Carotid Atherosclerosis in the presence of Metabolic Syndrome

2019 ◽  
Vol 16 (1) ◽  
pp. 39-45
Author(s):  
Cemal Kemaloglu ◽  
Melek Didem Kemaloglu
Keyword(s):  
Metabolic Syndrome ◽  
Liver Disease ◽  
Fatty Liver ◽  
Fatty Liver Disease ◽  
Carotid Atherosclerosis ◽  
Controlled Study ◽  
Control Group ◽  
Alcoholic Fatty Liver ◽  
Increased Risk ◽  
Alcoholic Fatty Liver Disease

Objective: The aim of this study is to identify the relationship between carotid intima-media thickness (c-imt) and non-alcoholic fatty liver disease (NAFLD), and to determine whether NAFLD is an independent predictor for the progression of atherosclerosis.  Method: This is a prospective randomized controlled study. 103 NAFLD patients who have hepatosteatosis with grade II and above were enrolled in this study. Patients were divided into NAFLD with metabolic syndrome (MS) and NAFLD without MS groups and compared with 50 healthy people. Basal demographic characteristics and C-imt of all patients and control group were measured.  Results: C-imt and carotid cross sectional area rates in the NAFLD groups were significantly higher than those in the control group. The mean and max. c-imt levels were significantly higher in the NAFLD group with metabolic syndrome (p<0,001). Homeostatic Model of Assessment-Insulin Resistance (HOMA-IR) levels were increased in the group with metabolic syndrome than those in the group without metabolic syndrome, with statistical significance (p<0.001). There was no difference in c-imt levels between HOMA-IR positive and negative groups (p=0.254) in patients with NAFLD and without metabolic syndrome. There was only a mild positive corelation between c-imt levels and high sensitive C-Reactive protein (hs-CRP) levels in metabolic syndrome positive group (p=0.026 r=0.30).  Conclusion: NAFLD was a significant predictor to determine the increased risk of carotid atherosclerosis. 

scholarly journals Metabolic syndrome and risk factors for non-alcoholic fatty liver disease

2012 ◽  
Vol 49 (1) ◽  
pp. 89-96 ◽  
Author(s):  
Mônica Rodrigues de Araújo Souza ◽  
Margareth de Fátima Formiga de Melo Diniz ◽  
José Eymard Moraes de Medeiros-Filho ◽  
Maria Salete Trigueiro de Araújo
Keyword(s):  
Risk Factors ◽  
Metabolic Syndrome ◽  
Liver Disease ◽  
Fatty Liver ◽  
Fatty Liver Disease ◽  
Experimental Studies ◽  
Final Analysis ◽  
Alcoholic Fatty Liver ◽  
Alcoholic Steatohepatitis ◽  
Alcoholic Fatty Liver Disease

CONTEXT: Non-alcoholic fatty liver disease (NAFLD), hepatic manifestation of metabolic syndrome, has been considered the most common liver disease nowadays, which is also the most frequent cause of elevated transaminases and cryptogenic cirrhosis. The greatest input of fatty acids into the liver and consequent increased beta-oxidation contribute to the formation of free radicals, release of inflammatory cytokines and varying degrees of hepatocytic aggression, whose histological expression may vary from steatosis (HS) to non-alcoholic steatohepatitis (NASH). The differentiation of these forms is required by the potential risk of progression to cirrhosis and development of hepatocellular carcinoma. OBJECTIVE: To review the literature about the major risk factors for NAFLD in the context of metabolic syndrome, focusing on underlying mechanisms and prevention. METHOD: PubMed, MEDLINE and SciELO data basis analysis was performed to identify studies describing the link between risk factors for metabolic syndrome and NAFLD. A combination of descriptors was used, non-alcoholic fatty liver disease, non-alcoholic steatohepatitis, metabolic syndrome and risk factors. At the end, 96 clinical and experimental studies, cohorts, meta-analysis and systematic reviews of great impact and scientific relevance to the topic, were selected. RESULTS: The final analysis of all these data, pointed out the central obesity, type 2 diabetes, dyslipidemia and hypertension as the best risk factors related to NAFLD. However, other factors were highlighted, such as gender differences, ethnicity, genetic factors and the role of innate immunity system. How these additional factors may be involved in the installation, progression and disease prognosis is discussed. CONCLUSION: Risk factors for NAFLD in the context of metabolic syndrome expands the prospects to 1) recognize patients with metabolic syndrome at high risk for NAFLD, 2) elucidate pathways common to other co-morbidities, 3) determine risk factors associated with a worse prognosis, 4) develop therapeutic strategies with goal of reducing risk factors, 5) apply acquired knowledge in public health policies focusing on preventive strategies.

scholarly journals Non-Alcoholic Fatty Liver Disease Is Associated with Kidney Glomerular Hyperfiltration in Adults with Metabolic Syndrome

2021 ◽  
Vol 10 (8) ◽  
pp. 1717
Author(s):  
Manuela Abbate ◽  
Catalina M. Mascaró ◽  
Sofía Montemayor ◽  
Miguel Casares ◽  
Cristina Gómez ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Liver Disease ◽  
Fatty Liver ◽  
Fatty Liver Disease ◽  
Glomerular Hyperfiltration ◽  
Estimated Gfr ◽  
Alcoholic Fatty Liver ◽  
Increased Risk ◽  
The Relationship ◽  
Alcoholic Fatty Liver Disease

Background: Non-alcoholic fatty liver disease (NAFLD) is a risk factor for the development of chronic kidney disease (CKD), which is early marked by kidney glomerular hyperfiltration. However, the association of NAFLD with kidney glomerular hyperfiltration has not been tested so far in adults with metabolic syndrome (MetS). Aims: To assess the relationship between NAFLD and kidney glomerular hyperfiltration in adults with MetS. Methods: The study included 154 participants aged 40–60 years with MetS and NAFLD diagnosed by ultrasound. NAFLD was confirmed by MRI in 109 subjects. Participants underwent anthropometric measurements, and biochemistry testing. Estimated GFR (eGFR) was calculated using the CKD-Epidemiology Collaboration (CKD-EPI) formula; hyperfiltration was defined as eGFR ≥ 120 mL/min. Results: Participants with MRI-proven NAFLD showed a worse metabolic profile and higher levels of eGFR than those with no NAFLD. Presence of NAFLD and increased weight were independently associated with an increased probability of presenting hyperfiltration. Conclusions: The present study shows an association between kidney glomerular hyperfiltration and NAFLD in adults with MetS. Establishing an association between NAFLD and kidney glomerular hyperfiltration would help to earlier identify those patients at increased risk of CKD, who would benefit from an early intervention.

scholarly journals Non-alcoholic fatty liver disease as a medical and social problem

2021 ◽  
Vol 3 (2) ◽  
pp. 71-80
Author(s):  
Margarita E. Semendyaeva
Keyword(s):  
Metabolic Syndrome ◽  
Liver Disease ◽  
Liver Fibrosis ◽  
Fatty Liver ◽  
Social Problem ◽  
Fatty Liver Disease ◽  
Diagnosis And Treatment ◽  
Alcoholic Fatty Liver ◽  
Alcoholic Steatohepatitis ◽  
Alcoholic Fatty Liver Disease

The article considers the non-alcoholic fatty liver disease as an important medical and social problem. This problem include such questions as metabolic syndrome, essential lipoproteinemia, insulinoresistance. It is possible to consider non-alcoholic steatohepatitis as predictor of liver fibrosis and chirrosis. The questions of diagnosis and treatment are discussed.

scholarly journals Ultrasonographic Evaluation of Fatty Pancreas in Serbian Patients with Non Alcoholic Fatty Liver Disease—A Cross Sectional Study

Medicina ◽  
2019 ◽  
Vol 55 (10) ◽  
pp. 697 ◽  
Author(s):  
Tamara Milovanovic ◽  
Sanja Dragasevic ◽  
Milica Stojkovic Lalosevic ◽  
Sanja Zgradic ◽  
Biljana Milicic ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Liver Disease ◽  
Fatty Liver ◽  
Scoring System ◽  
Fatty Liver Disease ◽  
P Value ◽  
Alcoholic Fatty Liver ◽  
Increased Risk ◽  
Fatty Pancreas ◽  
Alcoholic Fatty Liver Disease

Background and Objectives: The aim of the study was to determine the association between presences of fatty pancreas (FP) with the features of metabolic syndrome (MeS) in patients with non–alcoholic fatty liver disease (NAFLD) and to establish a new noninvasive scoring system for the prediction of FP in patients with NAFLD. Material and Methods: 143 patients with NAFLD were classified according to FP severity grade into the two groups and evaluated for diagnostic criteria of MeS. All patients underwent sonographic examination with adiposity measurements and the liver biopsy. Liver fibrosis was evaluated semi-quantitatively according to the METAVIR scoring system and using non-invasive markers of hepatic fibrosis. Results: Waist circumference (WC) was predictive for increased risk of FP in NAFLD patients. Elevated fasting plasma glucose, total cholesterol, serum amylase and lipase levels were associated with presence of severe FP (p value = 0.052, p value = 0.007, p value = 0.014; p value = 0.024, respectively). Presence of increased amounts of mesenteric fat was associated with severe FP (p value = 0.013). The results of this study demonstrated highly significant association between NAFLD and presence of FP. The model for predicting the presence of FP was designed with probability value above 6.5. Conclusion: Pancreatic fat accumulation leads to worsening of pancreatic function which in turns exacerbates severity of metabolic syndrome associated with both, NAFLD and NAFPD.

scholarly journals Συσχέτιση της μη αλκοολικής στεατοηπατίτιδας με την αρτηριακή σκληρία σε ασθενείς με μεταβολικό σύνδρομο πριν και μετά υπολιπιδαιμική αγωγή

2016 ◽  
Author(s):  
Κωνσταντίνος Καργιώτης
Keyword(s):  
Metabolic Syndrome ◽  
Liver Disease ◽  
Pulse Wave Velocity ◽  
Fatty Liver ◽  
Wave Velocity ◽  
Fatty Liver Disease ◽  
Pulse Wave ◽  
Alcoholic Fatty Liver ◽  
Alcoholic Steatohepatitis ◽  
Alcoholic Fatty Liver Disease

Προς το παρόν δεν υπάρχει καμία αποτελεσματική θεραπεία για τη μη αλκοολική λιπώδη νόσο του ήπατος (Non Alcoholic Fatty Liver disease, NAFLD) ή την προχωρημένη μορφή της τη μη αλκοολική στεατοηπατίτιδα (Non Alcoholic Steatohepatitis, NASH), η οποία μπορεί να εξελίχθη σε κίρρωση του ήπατος και τελικά σε ηπάτωμα. Σκοπός της μελέτης ήταν να διερευνηθεί η επίδραση της ροσουβαστατίνης σε ασθενείς με μεταβολικό σύνδρομο (Metabolic Syndrome, MetS) και NASH. Καθώς και η πιθανή συσχέτιση των μεταβολών της NASH με τις μεταβολές της αρτηριακής σκληρίας μετά τη χορήγηση υπολιπιδαιμικής αγωγής. Η προοπτική αυτή μελέτη περιελάμβανε 20 ασθενείς με MetS, δυσλιπιδαιμία και αποδεδειγμένη με βιοψία NASH. Οι ασθενείς έλαβαν συμβουλές τρόπου ζωής και έλαβαν θεραπεία για 12 μήνες με ροσουβαστατίνη (10 mg/ημέρα) ως μονοθεραπεία. Επανάληψη βιοψίας και επανάληψη του υπερηχογραφήματος του ήπατος διεξήχθησαν στο τέλος της μελέτης σε όλους τους ασθενείς. Τα ηπατικά ένζυμα, η γλυκόζη πλάσματος νηστείας, τα επίπεδα του ουρικού οξέος, και το προφίλ των λιπιδίων αξιολογούνταν κάθε 3 μήνες. Το πρωτεύον καταληκτικό σημείο ήταν ο βαθμός υποστροφής της μη αλκοολικής στεατοηπατίτιδας σε συνδυασμό με την ελάττωση των τιμών της ταχύτητας του σφυγμικού κύματος (Pulse Wave Velocity, PWV). Η επαναληπτική βιοψία ήπατος και το επαναληπτικό υπερηχογράφημα έδειξε πλήρη υποστροφής της NASH σε 19 ασθενείς καθώς και σημαντική βελτίωση των τιμών της PWV σε διαδοχικές ανά εξάμηνο μετρήσεις. Ο 20ος ασθενής, ο οποίος δεν είχε καμία βελτίωση, αλλά ούτε επιδείνωση, εμφάνισε αρτηριακή υπέρταση και αύξηση των επιπέδων των τριγλυκεριδίων κατά τη διάρκεια της μελέτης, κατά πάσα πιθανότητα λόγω των αλλαγών στον τρόπο ζωής, συμπεριλαμβανομένης και της κατάχρησης αλκοόλ. Οι δραστηριότητες των ηπατικών ενζύμων του ορού αλανινική αμινοτρανσφεράση, ασπαρτική αμινοτρανσφεράση, γάμμα-γλουταμυλοτρανσπεπτιδάση και αλκαλική φωσφατάση ομαλοποιήθηκαν από τον 6ο μήνα της θεραπείας. Η γλυκόζη νηστείας του πλάσματος και η τιμή της γλυκοζυλιωμένης αιμοσφαιρίνης μειώθηκαν στατιστικά. Οι τιμές των λιπιδίων ομαλοποιήθηκαν από τον 3ο μήνα της θεραπείας. Κανένας ασθενής δεν είχε MetS από τον 9ο μήνα της θεραπείας. Ο δείκτης μάζας σώματος και η περίμετρος της μέσης παρέμειναν αμετάβλητες κατά τη διάρκεια της μελέτης. Έτσι, οι μεταβολές στην ηπατική παθολογία και λειτουργία θα πρέπει να αποδοθούν αποκλειστικά στη μονοθεραπεία με ροσουβαστατίνη. Τα ευρήματα αυτά υποδηλώνουν ότι η μονοθεραπεία με ροσουβαστατίνη θα μπορούσε να βελτιώσει την αποδεδειγμένη με βιοψία στεατοηπατίτιδα με παράλληλη ευνοϊκή επίδραση της αρτηριακής σκληρίας και να προκαλέσει σημαντική βελτίωση των παραμέτρων του MetS εντός 12 μηνών. Αυτές οι επιδράσεις αλλά και η μείωση της γλυκόζης νηστείας του πλάσματος και των επιπέδων ουρικού οξέος στον ορό μπορεί να μειώσουν σημαντικά τον κίνδυνο της σχετιζόμενης με το καρδιαγγειακό σύστημα, αλλά και με το ήπαρ, νοσηρότητας και θνησιμότητας σε ασθενείς με μη αλκοολική στεατοηπατίτιδα. Αυτά τα ευρήματα χρειάζονται επιβεβαίωση από μεγαλύτερες μελέτες.

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