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      Non-alcoholic Fatty Liver Disease: A Clinical Update

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          Abstract

          Non-alcoholic fatty liver disease (NAFLD) is currently the most common chronic liver disease in developed countries because of the obesity epidemic. The disease increases liver-related morbidity and mortality, and often increases the risk for other comorbidities, such as type 2 diabetes and cardiovascular disease. Insulin resistance related to metabolic syndrome is the main pathogenic trigger that, in association with adverse genetic, humoral, hormonal and lifestyle factors, precipitates development of NAFLD. Biochemical markers and radiological imaging, along with liver biopsy in selected cases, help in diagnosis and prognostication. Intense lifestyle changes aiming at weight loss are the main therapeutic intervention to manage cases. Insulin sensitizers, antioxidants, lipid lowering agents, incretin-based drugs, weight loss medications, bariatric surgery and liver transplantation may be necessary for management in some cases along with lifestyle measures. This review summarizes the latest evidence on the epidemiology, natural history, pathogenesis, diagnosis and management of NAFLD.

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          Muscles, exercise and obesity: skeletal muscle as a secretory organ.

          Bente K. Pedersen, Mark A. Febbraio (2012)
          During the past decade, skeletal muscle has been identified as a secretory organ. Accordingly, we have suggested that cytokines and other peptides that are produced, expressed and released by muscle fibres and exert either autocrine, paracrine or endocrine effects should be classified as myokines. The finding that the muscle secretome consists of several hundred secreted peptides provides a conceptual basis and a whole new paradigm for understanding how muscles communicate with other organs, such as adipose tissue, liver, pancreas, bones and brain. However, some myokines exert their effects within the muscle itself. Thus, myostatin, LIF, IL-6 and IL-7 are involved in muscle hypertrophy and myogenesis, whereas BDNF and IL-6 are involved in AMPK-mediated fat oxidation. IL-6 also appears to have systemic effects on the liver, adipose tissue and the immune system, and mediates crosstalk between intestinal L cells and pancreatic islets. Other myokines include the osteogenic factors IGF-1 and FGF-2; FSTL-1, which improves the endothelial function of the vascular system; and the PGC-1α-dependent myokine irisin, which drives brown-fat-like development. Studies in the past few years suggest the existence of yet unidentified factors, secreted from muscle cells, which may influence cancer cell growth and pancreas function. Many proteins produced by skeletal muscle are dependent upon contraction; therefore, physical inactivity probably leads to an altered myokine response, which could provide a potential mechanism for the association between sedentary behaviour and many chronic diseases.
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            Pharmacological management of obesity: an endocrine Society clinical practice guideline.

            Caroline M Apovian, Louis Aronne, Daniel H. Bessesen … (2015)
            To formulate clinical practice guidelines for the pharmacological management of obesity.
            Article 0 comments Cited 331 times – based on 0 reviews     Review now
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              Epidemiology of Non-Alcoholic Fatty Liver Disease

              Stefano Bellentani, Federica Scaglioni, Mariano Marino … (2010)
              Non-alcoholic fatty liver disease (NAFLD) is rapidly becoming the most common liver disease worldwide. The prevalence of NAFLD in the general population of Western countries is 20–30%. About 2–3% of the general population is estimated to have non-alcoholic steatohepatitis (NASH), which may progress to liver cirrhosis and hepatocarcinoma. As a rule, the prevalence of NAFLD is higher in males and increases with increasing age, and it is influenced by the diagnostic method and the characteristics of the population, especially lifestyle habits. Population-based studies provide better estimates of the prevalence of NAFLD as compared to autoptic and clinical studies, but few such studies have been performed to date. The diagnosis of NAFLD in population studies is usually obtained by ultrasonography, which is known to underestimate the prevalence of fatty liver. The Dallas Heart Study and the Dionysos Study reported that 30% of the adults in the USA and 25% in Italy have NAFLD. In these studies, 79% and 55% of patients with NAFLD had normal aminotransferase levels, showing that liver enzymes are not surrogate markers of NAFLD in the general population. Noninvasive markers such as the fatty liver index obtained from the Dionysos Study may be useful to screen for NAFLD in the general population. The most important risk factors for NAFLD are male gender, age, obesity, insulin resistance and the cardiometabolic alterations that define the metabolic syndrome. The prevalence of NAFLD is 80–90% in obese adults, 30–50% in patients with diabetes and up to 90% in patients with hyperlipidemia. The prevalence of NAFLD among children is 3–10%, rising up to 40–70% among obese children. Moreover, pediatric NAFLD increased from about 3% a decade ago to 5% today, with a male-to-female ratio of 2:1. The incidence and natural history of NAFLD are still not well defined, but it is recognized that the majority of individuals with NAFLD do not develop NASH. The incidence of NAFLD is probably increasing in Western countries, strictly linked to lifestyle habits.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Clin Transl Hepatol
                Journal ID (iso-abbrev): J Clin Transl Hepatol
                Journal ID (publisher-id): JCTH
                Title: Journal of Clinical and Translational Hepatology
                Publisher: XIA & HE Publishing Inc.
                ISSN (Print): 2225-0719
                ISSN (Electronic): 2310-8819
                Publication date (Electronic): 26 July 2017
                Publication date (Print): 28 December 2017
                Volume: 5
                Issue: 4
                Pages: 384-393
                Affiliations
                [1 ]Department of Endocrinology, Diabetes & Metabolism, Royal Lancaster Infirmary, University Hospitals of Morecambe Bay NHS Trust, Lancaster, UK
                [2 ]Department of Medicine, Dorset County Hospital, Dorchester, UK
                [3 ]Department of Gastroenterology & Hepatology, Royal Bournemouth Hospital, Bournemouth, UK
                [4 ]Department of Gastroenterology & Hepatology, Hinchingbrooke Hospital, Hinchingbrooke, Huntingdon, UK
                Author notes
                * Correspondence to: Dr. Joseph M Pappachan, Department of Endocrinology, Diabetes & Metabolism, Royal Lancaster Infirmary, University Hospitals of Morecambe Bay NHS Trust, Lancaster, LA1 4RP, UK. E-mail: drpappachan@ 123456yahoo.co.in

                The authors have no conflicts of interests related to this publication.

                Prepared the initial draft (SB, BK), conceived the manuscript plan, and grossly modified the initial draft which had been prepared by (JMP), helped in draft modification and revision of the paper (NCR). All authors contributed to the literature search and writing of the final manuscript.

                Article
                Publisher ID: JCTH.2017.00013
                DOI: 10.14218/JCTH.2017.00013
                PMC ID: 5719196
                PubMed ID: 29226105
                SO-VID: e8bef1ab-c1c0-4778-9f2d-0abb1517ee79
                Copyright © © 2017 Authors.
                License:

                This article has been published under the terms of Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0), which permits noncommercial unrestricted use, distribution, and reproduction in any medium, provided that the following statement is provided. “This article has been published in Journal of Clinical and Translational Hepatology at DOI: 10.14218/JCTH.2017.00013 and can also be viewed on the Journal’s website at http://www.jcthnet.com”.

                History
                Date received : 24 February 2017
                Date revision received : 31 May 2017
                Date accepted : 24 June 2017
                Categories
                Subject: Review Article

                Keywords: nonalcoholic fatty liver disease (nafld),nonalcoholic steatohepatitis,nash,insulin resistance,metabolic syndrome,lifestyle interventions,bariatric surgery
                Data availability:
                Keywords: nonalcoholic fatty liver disease (nafld), nonalcoholic steatohepatitis, nash, insulin resistance, metabolic syndrome, lifestyle interventions, bariatric surgery

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