Expert Opinion on the Management of Non-Alcoholic Fatty Liver Disease (NAFLD) in the Middle East with a Focus on the Use of Silymarin

Non-alcoholic fatty disease (NAFLD) is amongst the leading causes of chronic liver disease worldwide. The prevalence of NAFLD in the Middle East is 32%, similar to that observed worldwide. The clinicians in this region face several challenges in diagnosing and treating patients with NAFLD. Additionally, there are no national or regional guidelines to address the concerns faced with current treatment options. Silymarin, derived from milk thistle, provides a rational and clinically proven approach to hepatoprotection. This article focuses on addressing regional diagnostic challenges and provides clear guidance and potential solutions for the use of Silymarin in the treatment of NAFLD in the Middle East. Both clinical and preclinical studies have highlighted the efficiency of Silymarin in managing NAFLD by reducing liver disease progression and improving patient symptoms and quality of life, alongside being safe and well tolerated. An expert panel of professionals from the Middle East convened to establish a set of regional-specific diagnostics. A consensus was established to aid general physicians to address the diagnostic challenges in the region. In conclusion, Silymarin can be considered beneficial in treating NAFLD and should be initiated as early as possible and continued as long as necessary.

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FibroTest for Evaluating Fibrosis in Non-Alcoholic Fatty Liver Disease Patients: A Systematic Review and Meta-Analysis

Journal of Clinical Medicine ◽

10.3390/jcm10112415 ◽

2021 ◽

Vol 10 (11) ◽

pp. 2415

Author(s):

Yasaman Vali ◽

Jenny Lee ◽

Jérôme Boursier ◽

René Spijker ◽

Joanne Verheij ◽

...

Keyword(s):

Liver Disease ◽

Fatty Liver ◽

Fatty Liver Disease ◽

Meta Analysis ◽

Advanced Fibrosis ◽

Alcoholic Fatty Liver ◽

Multiple Thresholds ◽

Meta Analyses ◽

Alcoholic Fatty Liver Disease

(1) Background: FibroTest™ is a multi-marker panel, suggested by guidelines as one of the surrogate markers with acceptable performance for detecting fibrosis in patients with non-alcoholic fatty liver disease (NAFLD). A number of studies evaluating this test have been published after publication of the guidelines. This study aims to produce summary estimates of FibroTest™ diagnostic accuracy. (2) Methods: Five databases were searched for studies that evaluated FibroTest™ against liver biopsy as the reference standard in NAFLD patients. Two authors independently screened the references, extracted data, and assessed the quality of included studies. Meta-analyses of the accuracy in detecting different levels of fibrosis were performed using the bivariate random-effects model and the linear mixed-effects multiple thresholds model. (3) Results: From ten included studies, seven were eligible for inclusion in our meta-analysis. Five studies were included in the meta-analysis of FibroTest™ in detecting advanced fibrosis and five in significant fibrosis, resulting in an AUC of 0.77 for both target conditions. The meta-analysis of three studies resulted in an AUC of 0.69 in detecting any fibrosis, while analysis of three other studies showed higher accuracy in cirrhosis (AUC: 0.92). (4) Conclusions: Our meta-analysis showed acceptable performance (AUC > 0.80) of FibroTest™ only in detecting cirrhosis. We observed more limited performance of the test in detecting significant and advanced fibrosis in NAFLD patients. Further primary studies with high methodological quality are required to validate the reliability of the test for detecting different fibrosis levels and to compare the performance of the test in different settings.

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Mo1546 Health-Related Quality of Life and Health Utilities in Patients With Non-Alcoholic Fatty Liver Disease

Gastroenterology ◽

10.1016/s0016-5085(16)33850-1 ◽

2016 ◽

Vol 150 (4) ◽

pp. S1141

Author(s):

Mehmet Sayiner ◽

Maria Stepanova ◽

Huong Pham ◽

Bashir Noor ◽

Mercedes Walters ◽

...

Keyword(s):

Quality Of Life ◽

Liver Disease ◽

Fatty Liver ◽

Fatty Liver Disease ◽

Health Related Quality ◽

Alcoholic Fatty Liver ◽

Related Quality ◽

Health Related ◽

Alcoholic Fatty Liver Disease

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Quality of life of patients with non-alcoholic fatty liver disease with different thyroid status

Medical alphabet ◽

10.33667/2078-5631-2021-35-57-61 ◽

2021 ◽

pp. 57-61

Author(s):

E. V. Chernyadeva ◽

A. E. Shklyaev

Keyword(s):

Quality Of Life ◽

Liver Disease ◽

Fatty Liver ◽

Fatty Liver Disease ◽

Primary Hypothyroidism ◽

Alcoholic Fatty Liver ◽

Personal Anxiety ◽

Alcoholic Fatty Liver Disease ◽

Ethylmethylhydroxypyridine Succinate

The aim. To study the quality of life and psychoemotional state of patients with non-alcoholic fatty liver disease against the background of primary hypothyroidism during the use of ethylmethylhydroxypyridine succinate.Materials and methods. 111 patients with non-alcoholic fatty liver were examined, among them 35 were without thyroid dysfunction, 55 with compensated primary hypothyroidism, 21 with decompensated hypothyroidism. The patients underwent general clinical, biochemical, enzyme-linked immunosorbent assays of blood, instrumental studies, testing according to psychological questionnaires.Results. With decompensation of hypothyroidism, a statistically significant increase in indicators of depression, situational and personal anxiety was revealed in comparison with patients without hypothyroidism. The examined patients showed an increase in the level of situational and personal anxiety. The presence of hypothyroidism in the examined patients significantly worsens these indicators, leading to an increase in the degree of anxiety, aggravated by decompensation of hypothyroidism. A positive dynamic was revealed in the correction of the psychoemotional status of patients in the observation group during the complex treatment with ethylmethylhydroxypyridine succinate: the severity of depression, situational and personal anxiety, manifestations of dyspeptic and reflux syndromes decreased.Conclusion. Hypothyroidism affects the quality of life and psycho-emotional state of patients with non-alcoholic fatty liver disease: it worsens the degree of depression, situational and personal anxiety. The addition of ethylmethylhydroxypyridine succinate to standard therapy with sodium levothyroxine in patients with non-alcoholic fatty liver disease in the setting of hypothyroidism improves the quality of life and psycho-emotional state.

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STRUCTURE OF PSYCHOLOGICAL DISORDERS IN PATIENTS WITH METABOLIC SYNDROME AND NON-ALCOHOLIC FAT LIVER DISEASE

10.12731/2658-4034-2021-12-4-2-340-348 ◽

2021 ◽

Author(s):

O. L. Moskalenko ◽

O. V. Smirnova ◽

E. V. Kasparov ◽

I. E. Kasparova

Keyword(s):

Liver Disease ◽

Fatty Liver Disease ◽

Treatment Process ◽

Psychosocial Adaptation ◽

Psychological Characteristics ◽

Alcoholic Fatty Liver ◽

Fat Liver ◽

The Individual ◽

Alcoholic Fatty Liver Disease

The article is devoted to the study of the psychological characteristics of the behavior of patients with non-alcoholic fatty liver disease (NAFLD). The manifestations of NAFLD are a powerful frustrating factor for patients, negatively affect the quality of life, hinder psychosocial adaptation and serve as the basis for the formation of chronic stress from the disease, which blocks the actual needs of the individual. Psychological factors are an important component in the clinical assessment of patients in connection with the individualization of the treatment process and secondary psychoprophylaxis, including methods of somato-centered and personality-centered psychotherapy.

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Hypoxia-Inducible Factors as Key Players in the Pathogenesis of Non-alcoholic Fatty Liver Disease and Non-alcoholic Steatohepatitis

Frontiers in Medicine ◽

10.3389/fmed.2021.753268 ◽

2021 ◽

Vol 8 ◽

Author(s):

Lorenz M. W. Holzner ◽

Andrew J. Murray

Keyword(s):

Transcription Factors ◽

Liver Disease ◽

Fatty Liver ◽

Fatty Liver Disease ◽

Treatment Options ◽

Redox Homeostasis ◽

Health Concern ◽

Alcoholic Fatty Liver ◽

Alcoholic Steatohepatitis ◽

Alcoholic Fatty Liver Disease

Non-alcoholic fatty liver disease (NAFLD) and its more severe form non-alcoholic steatohepatitis (NASH) are a major public health concern with high and increasing global prevalence, and a significant disease burden owing to its progression to more severe forms of liver disease and the associated risk of cardiovascular disease. Treatment options, however, remain scarce, and a better understanding of the pathological and physiological processes involved could enable the development of new therapeutic strategies. One process implicated in the pathology of NAFLD and NASH is cellular oxygen sensing, coordinated largely by the hypoxia-inducible factor (HIF) family of transcription factors. Activation of HIFs has been demonstrated in patients and mouse models of NAFLD and NASH and studies of activation and inhibition of HIFs using pharmacological and genetic tools point toward important roles for these transcription factors in modulating central aspects of the disease. HIFs appear to act in several cell types in the liver to worsen steatosis, inflammation, and fibrosis, but may nevertheless improve insulin sensitivity. Moreover, in liver and other tissues, HIF activation alters mitochondrial respiratory function and metabolism, having an impact on energetic and redox homeostasis. This article aims to provide an overview of current understanding of the roles of HIFs in NAFLD, highlighting areas where further research is needed.

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Non-alcoholic fatty liver disease progression and current research

Asian Pacific Journal of Health Sciences ◽

10.21276/apjhs.2019.6.1.26 ◽

2019 ◽

Vol 6 (1) ◽

pp. 189-198

Author(s):

Smriti Narayan ◽

Sonu Kumar Gupta ◽

Priyanka Singh ◽

Villayat Ali ◽

Malkhey Verma

Keyword(s):

Liver Disease ◽

Fatty Liver ◽

Disease Progression ◽

Fatty Liver Disease ◽

Alcoholic Fatty Liver ◽

Liver Disease Progression ◽

Alcoholic Fatty Liver Disease

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Non-Alcoholic Fatty Liver Disease in Lean and Non-Obese Individuals: Current and Future Challenges

Biomedicines ◽

10.3390/biomedicines9101346 ◽

2021 ◽

Vol 9 (10) ◽

pp. 1346

Author(s):

Mohammad Shafi Kuchay ◽

José Ignacio Martínez-Montoro ◽

Narendra Singh Choudhary ◽

José Carlos Fernández-García ◽

Bruno Ramos-Molina

Keyword(s):

Liver Disease ◽

Fatty Liver ◽

Fatty Liver Disease ◽

Current Treatment ◽

Normal Weight ◽

Health Concern ◽

Excess Body Weight ◽

Alcoholic Fatty Liver ◽

Lean Nafld ◽

Alcoholic Fatty Liver Disease

Non-alcoholic fatty liver disease (NAFLD), which approximately affects a quarter of the world’s population, has become a major public health concern. Although usually associated with excess body weight, it may also affect normal-weight individuals, a condition termed as lean/non-obese NAFLD. The prevalence of lean/non-obese NAFLD is around 20% within the NAFLD population, and 5% within the general population. Recent data suggest that individuals with lean NAFLD, despite the absence of obesity, exhibit similar cardiovascular- and cancer-related mortality compared to obese NAFLD individuals and increased all-cause mortality risk. Lean and obese NAFLD individuals share several metabolic abnormalities, but present dissimilarities in genetic predisposition, body composition, gut microbiota, and susceptibility to environmental factors. Current treatment of lean NAFLD is aimed at improving overall fitness and decreasing visceral adiposity, with weight loss strategies being the cornerstone of treatment. Moreover, several drugs including PPAR agonists, SGLT2 inhibitors, or GLP-1 receptor agonists could also be useful in the management of lean NAFLD. Although there has been an increase in research regarding lean NAFLD, there are still more questions than answers. There are several potential drugs for NAFLD therapy, but clinical trials are needed to evaluate their efficacy in lean individuals.

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