Pathogenesis and management issues for non-alcoholic fatty liver disease

Scientific paper - Original scientific paper

• Author: Marko Duvnjak
• Author: Ivan Lerotić
• Author: Neven Baršić
• Author: Vedran Tomašić
• Author: Lucija Virović Jukić
• Author: Vedran Velagić
• Author's institution: University of Zagreb; School of Medicine
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences

Abstract (english)

Nonalcoholic fatty liver disease (NAFLD) has, although it is a very common disorder, only relatively recently gained broader interest among physicians and scientists. Fatty liver has been documented in up to 10 to 15 percent of normal individuals and 70 to 80 percent of obese individuals. Although the pathophysiology of NAFLD is still subject to intensive research, several players and mechanisms have been suggested based on the substantial evidence. Excessive hepatocyte triglyceride accumulation resulting from insulin resistance is the first step in the proposed ‘two hit’ model of the pathogenesis of NAFLD. Oxidative stress resulting from mitochondrial fatty acids oxidation, NF-kB-dependent inflammatory cytokine expression and adipocytokines are all considered to be the potential factors causing second hits which lead to hepatocyte injury, inflammation and fibrosis. Although it was initially believed that NAFLD is a completely benign disorder, histologic follow-up studies have showed that fibrosis progression occurs in about a third of patients. A small number of patients with NAFLD eventually ends up with end-stage liver disease and even hepatocellular carcinoma. Although liver biopsy is currently the only way to confirm the NAFLD diagnosis and distinguish between fatty liver alone and NASH, no guidelines or firm recommendations can still be made as for when and in whom it is necessary. Increased physical activity, gradual weight reduction and in selected cases bariatric surgery remain the mainstay of NAFLD therapy. Studies with pharmacologic agents are showing promising results, but available data are still insufficient to make specific recommendations; their use therefore remains highly individual.

• Keywords (english): Fatty liver - diagnosis - epidemiology - etiology - metabolism - pathology - therapy; Liver - metabolism - pathology; Metabolic Syndrome X - complications - therapy; Biopsy; Combined Modality Therapy; Cytokines - metabolism; Diabetes Mellitus, Type 2 - complications; Disease Progression; Dyslipidemias - complications; Humans; Incidence; Insulin Resistance; Lipid Metabolism; Obesity - complications; Oxidative Stress; Patient Selection; Practice Guidelines as Topic; Prevalence; Risk Factors
• Language: english
• Publication type: Scientific paper - Original scientific paper
• Publication status: Published
• Peer review: Peer review
• Publication version: Accepted version
• Journal title: World Journal of Gastroenterology
• Numbering: vol. 13, no. 34, pp. 4539-4550
• p-ISSN: 1007-9327
• URN:NBN: urn:nbn:hr:105:111248
• Publication: 2007-09
• Document URL: https://www.wjgnet.com/1007-9327/full/v13/i34/4539.htm
• Type of resource: Text
• Access conditions: Open access
• Created on: 2024-03-28 09:11:45