Hepatic steatosis in obese patients: clinical aspects and prognostic significance

Abstract

Non-alcoholic fatty liver disease is a new clinicopathological condition of emerging importance, now recognized as the most common cause of abnormal liver tests. It is characterized by a wide spectrum of liver damage: simple steatosis may progress to advanced fibrosis and to cryptogenic cirrhosis through steatohepatitis, and ultimately to hepatocellular carcinoma. Obesity is the most significant single risk factor for the development of fatty liver, both in children and in adults; obesity is also predictive of the presence of fibrosis, potentially progressing to advanced liver disease. From a pathogenic point of view, insulin resistance plays a central role in the accumulation of triglycerides within the hepatocytes and in the initiation of the inflammatory cascade. Chronic hepatocellular injury, necroinflammation, stellate cell activation, progressive fibrosis and ultimately, cirrhosis may be initiated by peroxidation of hepatic lipids and injury-related cytokine release. In the last few years, several pilot studies have shown that treatment with insulin-sensitizing agents, anti-oxidants or cytoprotective drugs may be useful, but there is no evidence-based support from randomized clinical trials. Modifications in lifestyle (e.g. diet and exercise) to reduce obesity remain the mainstay of prevention and treatment of a disease, which puts a large number of individuals at risk of advanced liver disease in the near future.

Mesenteric fat thickness as an independent determinant of fatty liver

“…These findings were also in line with previous observation that fatty liver is associated with worse metabolic risk profile. [25][26][27][28][29] On multiple logistic regression, mesenteric fat thickness was the only abdominal fat deposit which showed significant association with fatty liver, independent of thickness of other abdominal fat deposits, body mass index, insulin resistance, lipid and blood pressure. These results are in line with the known metabolic properties of mesenteric fat which is directly drained by the portal vein (portal adipose tissue).…”

Subtle metabolic and liver gene transcriptional changes underlie diet-induced fatty liver susceptibility in insulin-resistant mice

“…Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease associated with insulin resistance [1,2]. Genetic and environmental factors, including dietary excess and inadequate exercise, contribute to NAFLD either directly or indirectly through inter-organ hormonal or metabolic signalling events [3,4].…”

The role of fatty acids in the development and progression of nonalcoholic fatty liver disease

“…Non-alcoholic fatty liver disease (NAFLD) is a newly emerging obesity-related disorder characterized by fatty infiltration of the liver in the absence of chronic alcohol consumption [4][5][6]. Similar to obesity, the prevalence of NAFLD has nearly doubled since 1980 [4,6,7].…”