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Review
. 2017 Dec 28;5(4):384-393.
doi: 10.14218/JCTH.2017.00013. Epub 2017 Jul 26.

Non-alcoholic Fatty Liver Disease: A Clinical Update

Joseph M Pappachan  1 , Shithu Babu  2 , Babu Krishnan  3 , Nishal C Ravindran  4
Affiliations
Review

Non-alcoholic Fatty Liver Disease: A Clinical Update

Joseph M Pappachan et al. J Clin Transl Hepatol. .

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.

Keywords: Bariatric surgery; Insulin resistance; Lifestyle interventions; Metabolic syndrome; NASH; Nonalcoholic fatty liver disease (NAFLD); Nonalcoholic steatohepatitis.

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Conflict of interest statement

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

Figures

Fig. 1.
Fig. 1.. Pathophysiological mechanisms involved in the development and complications of nonalcoholic fatty liver disease (NAFLD).
BAT, brown adipose tissue; DNL, de novo lipogenesis; FC, free cholesterol; FFA, free fatty acid; GLP-1, glucagon-like insulinotropic peptide; GNG, gluconeogenesis; IR, insulin resistance; LDL, low density lipoprotein; SeP, selenoprotein P; VLDL, very low density lipoprotein; WAT, white adipose tissue. Figure reproduced with permission from Petta et al.
Fig. 2.
Fig. 2.. Pathogenesis of nonalcoholic fatty liver disease and effects of various therapeutic interventions.
formula image + indicates positive effect and formula image- indicates negative effect.
See this image and copyright information in PMC

References

    1. Carr RM, Oranu A, Khungar V. Nonalcoholic fatty liver disease: pathophysiology and management. Gastroenterol Clin North Am. 2016;45:639–652. 10.1016/j.gtc.2016.07.003. - DOI - PMC - PubMed
    1. Schwimmer JB, Behling C, Newbury R, Deutsch R, Nievergelt C, Schork NJ, et al. Histopathology of pediatric nonalcoholic fatty liver disease. Hepatology. 2005;42:641–649. 10.1002/hep.20842. - DOI - PubMed
    1. Bataller R, Rombouts K, Altamirano J, Marra F. Fibrosis in alcoholic and nonalcoholic steatohepatitis. Best Pract Res Clin Gastroenterol. 2011;25:231–244. 10.1016/j.bpg.2011.02.010. - DOI - PubMed
    1. Adams L. Transient elastography in nonalcoholic fatty liver disease: making sense of echoes. Hepatology. 2010;51:370–372. 10.1002/hep.23422. - DOI - PubMed
    1. Browning JD, Szczepaniak LS, Dobbins R, Nuremberg P, Horton JD, Cohen JC, et al. Prevalence of hepatic steatosis in an urban population in the United States: impact of ethnicity. Hepatology. 2004;40:1387–1395. 10.1002/hep.20466. - DOI - PubMed

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