Nonalcoholic fatty liver disease-Synopsis of current developments
Date
2015
Authors
Onyekwere, CA
Ogbera, AO
Samaila, AA
Balogun, BO
Abdulkareem, FB
Journal Title
Journal ISSN
Volume Title
Publisher
Nigerian Journal of Clinical Practice
Abstract
Non-alcoholic fatty liver disease (NAFLD) which is defined as the accumulation of fat >5% of liver weight is increasingly
becoming an important cause of chronic liver disease. This article tries to chronicle advances that have occurred in the
understanding of the pathogenesis, pathology as well as the management of this disease. We have done a Medline search
on published work on the subject and reviewed major conference proceedings in the preceding years. The Pathogenesis
involves a multi-hit process in which increased accumulation of triglycerides in face of insulin resistance results in
increased susceptibility to inflammatory damage mediated by increased expression of inflammatory cytokines and
adipokines, oxidative stress and mitochondrial dysfunction, endoplasmic reticulum stress and gut derived endotoxemia.
An interplay of multiple metabolic genetic expression and environmental factors however determine which patient with
NAFLD will progress from simple steatosis to non-alcoholic steatohepatitis (NASH) and liver cirrhosis. The minimum
criteria for diagnosis of NASH are steatosis, ballooning and lobular inflammation; fibrosis is not required. The NASH
Clinical Research Network (CRN), histological scoring system is used to grade and stage the disease for standardization.
The management of NAFLD consists of treating liver disease as well as associated metabolic co-morbidities such as
obesity, hyperlipidaemia, insulin resistance and type 2 diabetes mellitus (T2DM). Patient education is important as their
insight and commitment is pivotal, and lifestyle modification is the first line of treatment. Improvement in liver histology in non-diabetic NASH patients has been reported with use of Vitamin E. Other liver-related therapies under investigations
include pentoxyfiylins, Caspar inhibitors, Resveratrol as well as probiotics. The prognosis (both overall and liver-related
mortality) for simple steatosis is not different from that of the general population however
Description
Review article
Keywords
Current development, nonalcoholic fatty liver disease, review, synopsis, update
Citation
Nigerian Journal of Clinical Practice • Nov-Dec 2015 • Vol 18 • Issue 6