Nonalcoholic fatty liver disease: Evolving paradigms

Abstract

In the last years new evidence has accumulated on nonalcoholic fatty liver disease (NAFLD) challenging the paradigms that had been holding the scene over the previous 30 years. NAFLD has such an epidemic prevalence as to make it impossible to screen general population looking for NAFLD cases. Conversely, focusing on those cohorts of individuals exposed to the highest risk of NAFLD could be a more rational approach. NAFLD, which can be diagnosed with either non-invasive strategies or through liver biopsy, is a pathogenically complex and clinically heterogeneous disease. The existence of metabolic as opposed to genetic-associated disease, notably including ”lean NAFLD” has recently been recognized. Moreover, NAFLD is a systemic condition, featuring metabolic, cardiovascular and (hepatic/extra-hepatic) cancer risk. Among the clinico-laboratory features of NAFLD we discuss hyperuricemia, insulin resistance, atherosclerosis, gallstones, psoriasis and selected endocrine derangements. NAFLD is a precursor of type 2 diabetes (T2D) and metabolic syndrome and progressive liver disease develops in T2D patients in whom the course of disease is worsened by NAFLD. Finally, lifestyle changes and drug treatment options to be implemented in the individual patient are also critically discussed. In conclusion, this review emphasizes the new concepts on clinical and pathogenic heterogeneity of NAFLD, a systemic disorder with a multifactorial pathogenesis and protean clinical manifestations. It is highly prevalent in certain cohorts of individuals who are thus potentially amenable to selective screening strategies, intensive follow-up schedules for early identification of liver-related and extrahepatic complications and in whom earlier and more aggressive treatment schedules should be carried out whenever possible.

Pathomorphological analysis of nonalcohoholic and alcoholic steathohepatitis adverse consequences

“…Сегодня доказано, что основной причиной смерти больных НАЖБ являются сердечно-сосудистые заболевания, у пациентов, страдаю-щих НАЖБ, также повышен риск смерти от раз-личных внепеченочных злокачественных новооб-разований [10,41]. Среди злокачественных ново-образований у больных НАЖБ доминирует рак органов желудочно-кишечного тракта (толстой кишки, пищевода, желудка и поджелудочной же-лезы), а также рак почки у мужчин и молочной железы у женщин [41,42].…”

“…Среди злокачественных ново-образований у больных НАЖБ доминирует рак органов желудочно-кишечного тракта (толстой кишки, пищевода, желудка и поджелудочной же-лезы), а также рак почки у мужчин и молочной железы у женщин [41,42]. Выводы 1.…”

Hyperlipidemia Determines Dysfunctional HDL Production and Impedes Cholesterol Efflux in the Small Intestine: Alleviation by Ginger Extract

“…Hyperlipidemia (HL) is a major risk factor for the development of hepatic steatosis and atherosclerosis, the main cause of cardiovascular diseases (CVD) worldwide . The small intestine (SI) is the body's entryway for dietary lipids.…”

“…Hyperlipidemia (HL) is a major risk factor for the development of hepatic steatosis and atherosclerosis, the main cause of cardiovascular diseases (CVD) worldwide. [1,2] The small intestine (SI) is the body's entryway for dietary lipids. In the last years, many studies have investigated its function as a target organ for the treatment of metabolic disorders and CVD.…”

Two drinks per day does not take your fatty liver away

“…NAFLD is now the most common liver disorder in Western countries and affects as many as 25%‐30% of adults, and NAFLD might shortly become the most common liver disease worldwide . Cardiovascular disease (CVD) and not liver disease is the leading cause of death among patients with NAFLD . Moderate drinking (vs. abstinence) has been associated with a lower risk of CVD in the general population.…”