NAFLD from a hepatologist‘s point of view
Authors:
Jan Šťovíček
Authors‘ workplace:
Interní klinika 2. LF UK a FN v Motole
Published in:
AtheroRev 2021; 6(3): 143-146
Category:
Reviews
Overview
NAFLD is a population disease that can be primarily considered a marker of cardiovascular risk. Despite the relatively small risk of progression of liver disease into more advanced stages, including cirrhosis, it is also a significant hepatologic problem due to its high incidence in the population.. Non-invasive diagnostic methods can be used in the search for people with more advanced forms of the disease, especially in primary care - either on the principle of calculated indices from laboratory-determined biomarkers or some of the elastographic methods. At the moment, the basis of therapy is an effort to influence the lifestyle and reduce weight. Pharmacotherapeutic treatment options are currently limited and should be reserved for selected patients with NASH with a higher stage of fibrosis.
Keywords:
Cirrhosis – cardiovacular risk – non-acolholic fatty liver disease (NAFLD) – nonalcoholic steatosis and steatohepatitis (NASH)
Sources
- EASL–EASD–EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease. J Hepatol 2016; 64(6): 1388–1402. Dostupné z DOI: <http://dx.doi.org/10.1016/j.jhep.2015.11.004>.
- Vernon G, Baranova A, Younossi ZM. Systematic review: the epidemiology and natural history of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in adults. Aliment Pharmacol Ther 2011; 34(3): 274–285. Dostupné z DOI: <http://dx.doi.org/10.1111/j.1365–2036.2011.04724.x>.
- Rinella M, Charlton M. The globalization of nonalcoholic fatty liver disease: Prevalence and impact on world health. Hepatology 2016; 64(1): 19–22. Dostupné z DOI: <http://dx.doi.org/10.1002/hep.28524>.
- Younossi ZM, Stepanova M, Negro F et al. Nonalcoholic fatty liver disease in lean individuals in the United States. Medicine (Baltimore) 2012; 91(6): 319–327. Dostupné z DOI: <http://dx.doi.org/10.1097/MD.0b013e3182779d49>.
- de Alwis NM, Day CP. Non-alcoholic fatty liver disease: the mist gradually clears. J Hepatol 2008; 48(Suppl 1): S104–112. Dostupné z DOI: <http://dx.doi.org/10.1016/j.jhep.2008.01.009>.
- Targher G, Day CP, Bonora E. Risk of Cardiovascular Disease in Patients with Nonalcoholic Fatty Liver Disease. N Engl J Med 2010; 363(14): 1341–1350. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJMra0912063>.
- Angul P, Hui JM, Marchesini G et al. The NAFLD fibrosis score: a noninvasive system that identifies liver fibrosis in patients with NAFLD. Hepatology 2007; 45(4): 846–854. Dostupné z DOI: <http://dx.doi.org/10.1002/hep.21496>.
- Harrison SA, Oliver D, Arnold HL et al. Development and validation of a simple NAFLD clinical scoring system for identifying patients without advanced disease. Gut 2008; 57(10): 1441–1447. Dostupné z DOI: <http://dx.doi.org/10.1136/gut.2007.146019>.
- Shah AG, Lydecker A, Murray K et al. Comparison of noninvasive markers of fibrosis in patients with nonalcoholic fatty liver disease. Clin Gastroenterol Hepatol; 7(10): 1104–1112. Dostupné z DOI: <http://dx.doi.org/10.1016/j.cgh.2009.05.033.
- Castera L, Vilgrain V, Angulo P. Noninvasive evaluation of NAFLD. Nat Rev Gastroenterol Hepatol 2013; 10(11): 666–675. Dostupné z DOI: <http://dx.doi.org/10.1038/nrgastro.2013.175>.
- Friedrich-Rust M, Romen D, Vermehren J et al. Acoustic radiation force impulse-imaging and transient elastography for non-invasive assessment of liver fibrosis and steatosis in NAFLD. Eur J Radiol 2012; 81(3): e325–331. Dostupné z DOI: <http://dx.doi.org/10.1016/j.ejrad.2011.10.029>.
- Petersen KF, Dufour S, Befroy D et al. Reversal of Nonalcoholic Hepatic Steatosis, Hepatic Insulin Resistance, and Hyperglycemia by Moderate Weight Reduction in Patients with Type 2 Diabetes. Diabetes 2005; 54(3): 603–608. Dostupné z DOI: <http://dx.doi.org/10.2337/diabetes.54.3.603>.
- Promrat K, Kleiner DE, Niemeier HM et al. Randomized controlled trial testing the effects of weight loss on nonalcoholic steatohepatitis. Hepatology 2010; 51(1): 121–129. Dostupné z DOI: <http://dx.doi.org/10.1002/hep.23276>.
- Romero-Gómez M, Zelber-Sagi S, Trenell M. Treatment of NAFLD with diet, physical activity and exercise. J Hepatol 2017; 67(4): 829–846. Dostupné z DOI: <http://dx.doi.org/10.1016/j.jhep.2017.05.016>.
- Rodriguez B, Torres DM, Harrison SA. Physical activity: an essential component of lifestyle modification in NAFLD. Nat Rev Gastroenterol Hepatol 2012; 9(12): 726–731. Dostupné z DOI: <http://dx.doi.org/10.1038/nrgastro.2012.200>.
- Sanyal AJ, Chalasani N, Kowdley KV et al. Pioglitazone, Vitamin E, or Placebo for Nonalcoholic Steatohepatitis. N Engl J Med 2010; 362(18): 1675–1685. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJMoa0907929>.
- Lavine JE, Schwimmer JB, van Natta ML et al. Effect of Vitamin E or Metformin for Treatment of Nonalcoholic Fatty Liver Disease in Children and Adolescents: The TONIC Randomized Controlled Trial. JAMA 2011; 305(16): 1659–1668. Dostupné z DOI: <http://dx.doi.org/10.1001/jama.2011.520>.
- Armstrong M, Gaunt JP, Aithal GP et al. Liraglutide safety and efficacy in patients with non-alcoholic steatohepatitis (LEAN): a multicentre, double-blind, randomised, placebo-controlled phase 2 study. Lancet 2016; 387(10019): 679–690. Dostupné z DOI: <http://dx.doi.org/10.1016/S0140–6736(15)00803-X>.
- Newsome PN, Buchholtz K, Cusi K et al. A Placebo-Controlled Trial of Subcutaneous Semaglutide in Nonalcoholic Steatohepatitis. N Engl J Med 2021; 384(12): 1113–1124. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJMoa2028395>.
- Kim DJ, Yoon S, Ji SC et al. Ursodeoxycholic acid improves liver function via phenylalanine/tyrosine pathway and microbiome remodelling in patients with liver dysfunction. Sci Rep 2018; 8(1): 11874. Dostupné z DOI: <http://dx.doi.org/10.1038/s41598–018–30349–1>.
- Lindor KD, Kowdley KV, Luketic VA et al. High-dose ursodeoxycholic acid for the treatment of primary sclerosing cholangitis. Hepatology 2009; 50(3): 808–814. Dostupné z DOI: <http://dx.doi.org/10.1002/hep.23082>.
- Dufour JF, Oneta CM, Gonvers JJ et al. Randomized placebo-controlled trial of ursodeoxycholic acid with vitamin e in nonalcoholic steatohepatitis. Clin Gastroenterol Hepatol 2006; 4(12): 1537–1543. Dostupné z DOI: <http://dx.doi.org/10.1016/j.cgh.2006.09.025>.
- Leuschner UF, Lindenthal B, Herrmann G et al. High-dose ursodeoxycholic acid therapy for nonalcoholic steatohepatitis: a double-blind, randomized, placebo-controlled trial. Hepatology 2010; 52(2): 472–479. Dostupné z DOI: <http://dx.doi.org/10.1002/hep.23727>.
- Ratziu V, de Ledinghen V, Oberti F et al. A randomized controlled trial of high-dose ursodesoxycholic acid for nonalcoholic steatohepatitis. J Hepatol 2011; 54(5): 1011–1019. Dostupné z DOI: <http://dx.doi.org/10.1016/j.jhep.2010.08.030>.
- Ratziu V, Sanyal AJ, Loomba R et al. REGENERATE: Design of a pivotal, randomised, phase 3 study evaluating the safety and efficacy of obeticholic acid in patients with fibrosis due to nonalcoholic steatohepatitis. Contemp Clin Trials 2019; 84: 105803. Dostupné z DOI: <http://dx.doi.org/10.1016/j.cct.2019.06.017>.
- Bril F, Biernacki DM, Kalavalapalli S et al. Role of Vitamin E for Nonalcoholic Steatohepatitis in Patients With Type 2 Diabetes: A Randomized Controlled Trial. Diabetes Care 2019; 42(8): 1481–1488. Dostupné z DOI: <http://dx.doi.org/10.2337/dc19–0167>.
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Athero Review
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