Non-alcoholic fatty liver disease in adults 2021: A clinical practice guideline of the Italian Association for the Study of the Liver (AISF), the Italian Society of Diabetology (SID) and the Italian Society of Obesity (SIO)

Marchesini, Giulio; Bugianesi, Elisabetta; Marra, Fabio; Miele, Luca; Vajro, P.; Masarone, Mario; Petta, Salvatore; Persico, Marcello; Svegliati‐Baroni, Gianluca; Valenti, Luca; Federici, Massimo; Purrello, Francesco; Sasso, Ferdinando Carlo; Targher, Giovanni; Busetto, Luca; Petroni, Maria Letizia; Santini, Ferruccio; Cammà, Calogero; Colli, Agostino

doi:10.1016/j.numecd.2021.04.028

Cited by 21 publications

(7 citation statements)

References 277 publications

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“…Scientific associations (ESPEN, APASL, AASLD) emphasize the importance of losing weight using a low-calorie diet (500–1000 kcal/day deficit), as well as the importance of physical activity in reducing IR; however, there are no detailed guidelines in the form of type of diet and exercise [ 102 , 103 , 104 ]. Most scientific societies indicate the Mediterranean diet as the most beneficial model of nutrition for NAFLD patients, which is confirmed by numerous scientific studies [ 102 , 105 ]. At the same time, these scientific societies indicate that there is insufficient scientific evidence for considering macronutrient distribution as significant.…”

Section: Nutrition—what Is Beyond the Obvious?mentioning

confidence: 88%

Small Intestinal Bacterial Overgrowth and Non-Alcoholic Fatty Liver Disease: What Do We Know in 2023?

Gudan

Kozłowska-Petriczko

Bodnarczuk³

et al. 2023

Nutrients

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Non-alcoholic fatty liver disease (NAFLD) is a chronic liver disease associated with the pathological accumulation of lipids inside hepatocytes. Untreated NAFL can progress to non-alcoholic hepatitis (NASH), followed by fibrosis, cirrhosis, and hepatocellular carcinoma (HCC). The common denominator of the above-mentioned metabolic disorders seems to be insulin resistance, which occurs in NAFLD patients. Obesity is the greatest risk factor for lipid accumulation inside hepatocytes, but a part of the NAFLD patient population has a normal body weight according to the BMI index. Obese people with or without NAFLD have a higher incidence of small intestinal bacterial overgrowth (SIBO), and those suffering from NAFLD show increased intestinal permeability, including a more frequent presence of bacterial overgrowth in the small intestine (SIBO). The health consequences of SIBO are primarily malabsorption disorders (vitamin B12, iron, choline, fats, carbohydrates and proteins) and bile salt deconjugation. Undetected and untreated SIBO may lead to nutrient and/or energy malnutrition, thus directly impairing liver function (e.g., folic acid and choline deficiency). However, whether SIBO contributes to liver dysfunction, decreased intestinal barrier integrity, increased inflammation, endotoxemia and bacterial translocation is not yet clear. In this review, we focus on gut–liver axis and discuss critical points, novel insights and the role of nutrition, lifestyle, pre- and probiotics, medication and supplements in the therapy and prevention of both SIBO and NAFLD.

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Section: Nutrition—what Is Beyond the Obvious?mentioning

confidence: 88%

Small Intestinal Bacterial Overgrowth and Non-Alcoholic Fatty Liver Disease: What Do We Know in 2023?

Gudan

Kozłowska-Petriczko

Bodnarczuk³

et al. 2023

Nutrients

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“…We need to strengthen the relation between the different nods involved in NAFLD care (hepatology, obesity, diabetes Units) to favor appropriate treatment [3,29,30]. Also, in Italy, the three principal associations of hepatology, diabetes and obesity issued a common guideline to promote cooperation [31], and in various centers shared protocols have been developed.…”

Section: Discussionmentioning

confidence: 99%

Risk of Binge Eating Disorder in Patients With Non-Alcoholic Fatty Liver Disease Screened for Metabolic Features

Brodosi,

Stecchi,

Marchignoli

et al. 2023

Preprint

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Purpose - Very few data exist on the association between non-alcoholic fatty liver disease (NAFLD) and eating disorders. The study was aimed to evaluate the presence of binge eating disorder (BED), frequently associated with obesity, in NAFLD subjects screened for the features of metabolic syndrome. Methods - Demographic, clinical investigation, anthropometric measurements and laboratory were collected in 129 patients with NAFLD (34.1% males; age, 53.7 years; BMI, 34.4 kg/m2) addressed by general practitioners to a hospital-based unit of metabolic disorders. The risk of binge eating was tested by the binge eating scale (BES); values in the range 17-26 were considered “possible” BED, values > 26 were considered “probable” BED. Hepatic steatosis and fibrosis were tested by surrogate biomarkers and imaging (transient elastography). Calorie intake and lifestyle were self-assessed by questionnaires. Results - Possible BED was present in 17.8% of cases, probable BED in another 7.6%, and were neither associated with gender, obesity class, diabetes, features of metabolic syndrome, nor with presence and severity of hepatic steatosis and fibrosis. Also steatosis grade by CAP and fibrosis stage by liver stiffness did not correlate with BES. However, an association was present between the daily caloric intake and “possible” BED (odds ratio, 1.14; 95% confidence interval, 1.05-1.24; “probable” BED, 1.21; 1.07-1.37), after adjustment for confounders. Conclusion - Binge eating, as scored by BES, is present in a significant proportion of NAFLD cases screened for metabolic disorders. It may impact behavioral treatment, reducing the chance of weight loss without systematic psychological support.

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“…The treatment of NAFLD patients relies on lifestyle modifications, with the necessity to lose !7-10% of the initial body weight through diet and exercise, because lower weight is associated with improvement in liver histology and liver enzyme levels [3 recommendation [4]. Yet, current European guidelines [5 && ] and multisociety Italian guidelines [6] suggest adherence to the Mediterranean diet because it showed beneficial effects both on liver histology and on some cardiovascular parameters [7]. In this review, we discussed the role of the major players in the development of NAFLD.…”

Section: Andandmentioning

confidence: 99%

“…The lack of rigorous prospective trials comparing various diets in NAFLD has prevented the American Gastroenterological Association from adding a specific macronutrient diet recommendation [4]. Yet, current European guidelines [5 ▪▪ ] and multisociety Italian guidelines [6] suggest adherence to the Mediterranean diet because it showed beneficial effects both on liver histology and on some cardiovascular parameters [7]. In this review, we discussed the role of the major players in the development of NAFLD…”

Section: Introductionmentioning

confidence: 99%

Physiopathology of nonalcoholic fatty liver disease: from diet to nutrigenomics

Meneghel¹,

Pinto²,

Russo³

2022

Current Opinion in Clinical Nutrition &Amp; Metabolic Care

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Purpose of review Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease worldwide and is strongly associated with metabolic disorders, such as obesity, type 2 diabetes mellitus, and metabolic syndrome, to the extent that a new definition of metabolic associated fatty liver disease has been proposed. Recent findings Insulin resistance, worsened by a high-fat and high-carbohydrate diet, is the key to the physiopathology of hepatic steatosis. This is driven by several mechanisms that are mostly activated at a genetic level, such as de-novo lipogenesis and triglyceride synthesis. Therefore, many diet regimens have been studied, although significant controversies remain regarding their metabolic effects and long-term sustainability. Summary In this review, we summarized the role and effects of the main macronutrients on the development of NAFLD and discussed the molecular mechanisms involved. We also discussed the importance of genetic polymorphisms, epigenetic alterations, and dysbiosis to determine if lifestyle modification and a specific dietary regimen could be an essential part of NAFLD treatment.

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Non-alcoholic fatty liver disease in adults 2021: A clinical practice guideline of the Italian Association for the Study of the Liver (AISF), the Italian Society of Diabetology (SID) and the Italian Society of Obesity (SIO)

Cited by 21 publications

References 277 publications

Small Intestinal Bacterial Overgrowth and Non-Alcoholic Fatty Liver Disease: What Do We Know in 2023?

Small Intestinal Bacterial Overgrowth and Non-Alcoholic Fatty Liver Disease: What Do We Know in 2023?

Risk of Binge Eating Disorder in Patients With Non-Alcoholic Fatty Liver Disease Screened for Metabolic Features

Physiopathology of nonalcoholic fatty liver disease: from diet to nutrigenomics

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