Histological subclassification of cirrhosis (original) (raw)
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The riddle of Nonalcoholic fatty liver disease: Progression from NAFL to NASH
Journal of Clinical and Experimental Hepatology, 2015
Nonalcoholic fatty liver (NAFL) is an emerging global epidemic which progresses to nonalcoholic steatohepatitis (NASH) and cirrhosis in a subset of subjects. Various reviews have focused on the etiology, epidemiology, pathogenesis and treatment of NAFLD. This review highlights specifically the triggers implicated in disease progression from NAFL to NASH. The integrating role of genes, dietary factors, innate immunity, cytokines and gut microbiome have been discussed. ( J CLIN EXP HEPATOL 2015;-:1-12) N on alcoholic fatty liver disease (NAFLD) is an emerging medical problem worldwide which affects a significant proportion of the western population and there is gradual spread of this epidemic to south-east Asian countries. NAFLD encompasses two entities: Non-alcoholic fatty liver (NAFL) and Nonalcoholic steatohepatitis (NASH). NAFL is defined as the evidence of hepatic steatosis without inflammation either by imaging or by histology in individuals without significant alcohol consumption in whom secondary causes of steatosis are absent. 1 NASH on the other hand, is characterized by the presence of both steatosis and inflammation with evidence of hepatocyte injury in the form of ballooning with or without fibrosis. The prevalence of NAFLD has been gradually increasing and one third adult Americans have NAFLD. 2 The prevalence in obese population may be as high 57.55-74%. The global spread of this epidemic is evidenced by the presence NAFL in 36.8% of Mediterranean, 21.5% of Iranians and 27% of urban Chinese adults. 5-7 However, the prevalence varies between countries and continents. The prevalence in Europe is 20-30% while that in Japan varies between 9 and 30% 8,9 and in China between 5 and 24%. 10 In India, the prevalence of NAFLD in urban population is 16%-32% while that in rural areas is approximately 9%. 11-13 Among the Asian countries the lowest prevalence is observed in Singapore at 5%. 10 Globally NAFLD has been related to obesity and sedentary lifestyle. Interestingly both NAFL and NASH have been observed in non-obese subjects in Asians, which is referred to as the Asian paradox. Mere presence of fat in the hepatocytes is not considered as a disease. As most of the subjects with NAFL do not progress to NASH, differentiation between these two conditions is paramount. Though liver histology is the
Non-alcoholic fatty liver disease (NAFLD)--the hepatic component of metabolic syndrome
The Journal of the Association of Physicians of India, 2009
To study the prevalence of NAFLD in those patients attending the routine health checkup and to establish a relationship between NAFLD and metabolic syndrome. All patients attending the health check-up had their blood pressure, height and weight, waist circumference measurements, blood sugars, lipid levels and ultrasound abdomen done. The prevalence of NAFLD among these subjects was determined and the presence of risk factors for metabolic disease in each individual was analysed. A relationship between NAFLD and metabolic syndrome was then established. Of the 1003 people 225 (22.6%) had NAFLD with higher prevalence among males 164/565 (29%) than among females 61/438 (13.9%). In the NAFLD group normal body mass index (BMI) was present in only 49/225 (20%) of the subjects while 119/225 (52.8%) were overweight and 56/225 (24.8%) were obese. Though liver enzymes were normal the mean AST among cases was 37.41 +/- 14.50 and 33.93 +/- 14.15 among controls and the mean ALT was 38.74 +/- 17.9...
Hepatology, 2005
The prevalence of and the risk factors for fatty liver have not undergone a formal evaluation in a representative sample of the general population. We therefore performed a crosssectional study in the town of Campogalliano (Modena, Italy), within the context of the Dionysos Project. Of 5,780 eligible persons aged 18 to 75 years, 3,345 (58%) agreed to participate in the study. Subjects with suspected liver disease (SLD), defined on the basis of elevated serum alanine aminotransferase (ALT) and ␥-glutamyl-transferase (GGT) activity, hepatitis B surface antigen (HBsAg), or hepatitis C virus (HCV)-RNA positivity, were matched with randomly selected subjects of the same age and sex without SLD. A total of 311 subjects with and 287 without SLD underwent a detailed clinical, laboratory, and anthropometrical evaluation. Fatty liver was diagnosed by ultrasonography, and alcohol intake was assessed by using a 7-day diary. Multinomial logistic regression was used to detect risk factors for normal liver versus nonalcoholic fatty liver disease (NAFLD) and for alcoholic fatty liver (AFLD) versus NAFLD. The prevalence of NAFLD was similar in subjects with and without SLD (25 vs. 20%, P ؍ .203). At multivariable analysis, normal liver was more likely than NAFLD in older subjects and less likely in the presence of obesity, hyperglycemia, hyperinsulinemia, hypertriglyceridemia, and systolic hypertension; AFLD was more likely than NAFLD in older subjects, males, and in the presence of elevated GGT and hypertriglyceridemia, and less likely in the presence of obesity and hyperglycemia. In conclusion, NAFLD is highly prevalent in the general population, is not associated with SLD, but is associated with many features of the metabolic syndrome. (HEPATOLOGY 2005;42:44-52.) From the 1 Centro Studi
Factors That Predict the Progression of Non-alcoholic Fatty Liver Disease (NAFLD)
Cureus, 2021
Non-alcoholic fatty liver disease (NAFLD) refers to a spectrum of diseases involving the deposition of fat in the hepatocytes of people with little to no alcohol consumption. NAFLD is associated with hypertension, diabetes, obesity, etc. As their prevalence increases, the propensity and severity of NAFLD might increase. As per the recently developed multi-hit hypothesis, factors like oxidative stress, genetic predisposition, lipotoxicity, and insulin resistance have been found to play a key role in the development of NAFLD and its associated complications. This article focuses on NAFLD, its pathophysiology, risk factors, and the various genetic and epigenetic factors involved in its development along with possible treatment modalities. We conducted an all-language literature search on Medline, Cochrane, Embase, and Google Scholar until October 2021. The following search strings and Medical Subject Heading (MeSH) terms were used: "NAFLD," "NASH," "Fibrosis," and "Insulin Resistance." We explored the literature on NAFLD for its epidemiology, pathophysiology, the role of various genes, and how they influence the disease and associated complications about the disease and its hepatic and extrahepatic complications. With its rapidly increasing prevalence rates across the world and serious complications like NASH and hepatocellular carcinoma, NAFLD is becoming a major public health issue and more research is needed to formulate better screening tools and treatment protocols.
Abstract— Non Alcoholic Fatty Liver Disease is also becoming public health impotance nowadays. So this study was aimed to determine the association of Non Alcoholic Fatty Liver Disease with metabolic syndrome and Cardio-Vascular disease along with assessment of degree of severity of NAFLD with respect to number of components of metabolic syndrome. This study includes a total of 222 subjects were enrolled as per the inclusion/exclusion criteria, out of which 110 cases who had NAFLD with hepatic steatosis on ultrasonography and 112 subjects who did not have NAFLD were considered control. These cases and controls were interrogated and investigated further. Observations were recorded and association of Non Alcoholic Fatty Liver Disease with metabolic syndrome and Cardio-Vascular disease along with assessment of degree of severity of NAFLD with respect to number of components of metabolic syndrome. Statistical methods used were unpaired student’s t-test for continuous variables, Fischer’s and chi-sq test for categorical variables using bivariate analysis by Graph Pad Instat Version 3.10. Risk was assessed in terms of Odd's Ratio. The patients with MS and NAFLD had a higher proportion of CVD compared with those who did not have NAFLD (29.1 vs 18.1 %). This study concludes that NAFLD is significantly associated with MS; most significant with WC, followed by TG and FBS and thus can be considered as hepatic component of MS. This needs more research with large multi-centric prospective studies to evaluate NAFLD as an independent risk factor for CVD.
Hepatology International, 2018
Introduction While patients with non-alcoholic fatty liver disease (NAFLD) are mostly overweight or obese, some are lean. Methods In a community-based follow-up study (baseline and follow-up surveys performed in 2007 and 2014), we investigated and compared the clinical characteristics, body composition, metabolic associations and outcomes, and other risk factors among individuals with lean (BMI < 23 kg/m 2) NAFLD, non-lean (BMI ≥ 23 kg/m 2) NAFLD and those without NAFLD. To investigate associations of selected genetic variants, we performed a case-control study between lean NAFLD cases and lean non-NAFLD controls. Results Of the 2985 participants in 2007, 120 (4.0%) had lean NAFLD and 816 (27.3%) had non-lean NAFLD. 1206 (40.4%) had no evidence of NAFLD (non-NAFLD). Compared to non-lean NAFLD, lean NAFLD was commoner among males (p < 0.001), and had a lower prevalence of hypertension (p < 0.001) and central obesity (WC < 90 cm for males, < 80 cm for females) (p < 0.001) without prominent differences in the prevalence of other metabolic comorbidities at baseline survey. Of 2142 individuals deemed as either NAFLD or non-NAFLD in 2007, 704 NAFLD individuals [84 lean NAFLD, 620 non-lean NAFLD] and 834 individuals with non-NAFLD in 2007 presented for follow-up in 2014. There was no difference in the occurrence of incident metabolic comorbidities between lean NAFLD and non-lean NAFLD. Of 294 individuals who were non-NAFLD in 2007 and lean in both 2007 and 2014, 84 (28.6%) had developed lean NAFLD, giving an annual incidence of 4.1%. Logistic regression identified the presence of diabetes at baseline, increase in weight from baseline to follow-up and a higher educational level as independent risk factors for the development of incident lean NAFLD. NAFLD association of PNPLA3 rs738409 was more pronounced among lean individuals (one-tailed p < 0.05) compared to the whole cohort sample. Conclusion Although lean NAFLD constitutes a small proportion of NAFLD, the risk of developing incident metabolic comorbidities is similar to that of non-lean NAFLD. A PNPLA3 variant showed association with lean NAFLD in the studied population. Therefore, lean NAFLD also warrants careful evaluation and follow-up.
Epidemiology of Non-Alcoholic Fatty Liver Disease
Digestive Diseases, 2010
general population. The most important risk factors for NAFLD are male gender, age, obesity, insulin resistance and the cardiometabolic alterations that define the metabolic syndrome. The prevalence of NAFLD is 80-90% in obese adults, 30-50% in patients with diabetes and up to 90% in patients with hyperlipidemia. The prevalence of NAFLD among children is 3-10%, rising up to 40-70% among obese children. Moreover, pediatric NAFLD increased from about 3% a decade ago to 5% today, with a male-to-female ratio of 2: 1. The incidence and natural history of NAFLD are still not well defined, but it is recognized that the majority of individuals with NAFLD do not develop NASH. The incidence of NAFLD is probably increasing in Western countries, strictly linked to lifestyle habits.