Volume : 10, Issue : 10, October – 2023

Title:

NON-ALCOHOLIC FATTY LIVER DISEASE (NAFLD): A REVIEW OF PATHOPHYSIOLOGY AND CLINICAL MANAGEMENT

Authors :

Elham Yahya Baamer, Zainab Naji Alaithan, Abdullah Mohammad Alshumrani, Mohammed Hamdan Alwabisi, Mohammed Yousef A Alali, Aram Faleh Alharbi, Haytham Nabil Alhazmi, Anan Ali Baamer, Abdulmajeed Abed M Aljuaid, Ashwaq Fathi Aldossary, Rashed Abdullah Bati Alsaeedi, Fatimah Ahmed Althubyani, Deyala Mohammed Badawi, Bayan Mohammed H Alhashidi

Abstract :

Introduction: The harmful effects of non-alcoholic fatty liver disease (NAFLD) are becoming a significant problem for public health due to the rising incidence of diabetes and obesity worldwide. In the Western world, NAFLD is the most prevalent chronic liver disease. Metabolic problems such as central obesity, dyslipidemia, hypertension, hyperglycemia, and recurrent abnormalities in liver function tests are all intimately related to NAFLD. In general, NAFLD is a term used to describe a wide range of liver diseases, including fibrosis, inflammation, and hepatocyte injury. This is typically detected through a liver biopsy and can take a variety of forms, from lesser forms (steatosis) to more severe forms (cirrhosis, advanced fibrosis, non-alcoholic steatohepatitis, and liver failure). A precise diagnosis of NASH and NAFLD is essential since severe fibrosis is the main indicator of morbidity and liver-related death in these patients. The gold standard for diagnosing NAFLD continues to be histologic assessment with liver biopsy. The presence of hepatic steatosis, ballooning, and lobular inflammation with or without fibrosis is required for the diagnosis of NAFLD. Once the diagnosis is made, the pillars of treatment are still weight loss, dietary changes, and the management of the underlying metabolic syndrome. Once a diagnosis is made, the fundamentals of therapy continue to be dietary advice and lifestyle changes, weight loss, and the treatment of the underlying metabolic syndrome, all of which show promise but are challenging to sustain. Guidelines prescribe pioglitazone and vitamin E in some people.
Aim of the study: Clinicians encounter difficulties due to the complexity of NAFLD and related diseases, especially its association with metabolic syndrome. The pathophysiology of NAFLD, risk factors, diagnostic techniques, and conservative and surgical treatment options are all summarised in this review. An overview of NAFLD and available treatments is provided in this review.
Methodology: The present review is a comprehensive research of PUBMED since the year 1995 to 2023
Conclusion: The management of these patients has grown more challenging due to the expanding obesity pandemic and the increased frequency of concomitant disorders, including T2DM and NAFLD. There are several therapy options; however, there isn’t much high-quality research that compares them with one another. Prospective studies addressing the remaining uncertainties regarding the relationship between insulin resistance, fatty liver, and fibrosis progression should be made accessible soon, given the rising popularity of bariatric surgery.
Keywords: Non-alcoholic fatty liver disease (NAFLD), obesity, dyslipidemia, hypertension, hyperglycemia, liver failure etc.

Cite This Article:

Please cite this article in Elham Yahya Baamer et al . Non-alcoholic fatty liver disease (nafld): A review of pathophysiology and clinical management, Indo Am. J. P. Sci, 2023; 10 (10).

Number of Downloads : 10

References:

Harrison S A (2015). Non-alcoholic fatty liver disease review: diagnosis, treatment, and outcomes. Clinical Gastroenterology and Hepatology, 13(12), 2062-2070.
2. Machado M V, & Diehl A M (2016). Pathogenesis of non-alcoholic steatohepatitis. Gastroenterology, 150(8), 1769-1777.
3. Dixon J B, Bhathal P S, & O’brien P E (2001). Non-alcoholic fatty liver disease: predictors of non-alcoholic steatohepatitis and liver fibrosis in the severely obese. Gastroenterology, 121(1), 91-100.
4. Clark J M, Brancati F L, & Diehl, A M (2003). The prevalence and etiology of elevated aminotransferase levels in the United States. The American journal of gastroenterology, 98(5), 960-967.
5. Grande C, Grabherr F, & Tilg H (2023). Non-alcoholic fatty liver disease: pathophysiological concepts and treatment options. Cardiovascular research, cvad095.
6. Méndez-Sánchez N, Bugianesi E, Gish R G, Lammert F, Tilg H, Nguyen M H, & Awny S. (2022). Global multi-stakeholder endorsement of the MAFLD definition. The lancet Gastroenterology & hepatology, 7(5), 388-390.
7. BasuRay S, Smagris E, Cohen J C, & Hobbs H H (2017). The PNPLA3 variant associated with fatty liver disease (I148M) accumulates on lipid droplets by evading ubiquitylation. Hepatology, 66(4), 1111-1124.
8. Herman M A, & Samuel V T. (2016). The sweet path to metabolic demise: fructose and lipid synthesis. Trends in Endocrinology & Metabolism, 27(10), 719-730.
9. Hoyles L, Fernandez-Real J M, Federici M, Serino M, Abbott J, Charpentier J, & Dumas M E (2018). Molecular phenomics and metagenomics of hepatic steatosis in non-diabetic obese women. Nature medicine, 24(7), 1070-1080.
10. Zhu L, Baker S S, Gill C, Liu W, Alkhouri R, Baker R D, & Gill S R (2013). Characterization of gut microbiomes in non-alcoholic steatohepatitis (NASH) patients: a connection between endogenous alcohol and NASH. Hepatology, 57(2), 601-609.
11. Rau M, Rehman A, Dittrich M, Groen A K, Hermanns H M, Seyfried F, & Geier A (2018). Fecal SCFAs and SCFA-producing bacteria in gut microbiome of human NAFLD as a putative link to systemic T-cell activation and advanced disease. United European gastroenterology journal, 6(10), 1496-1507.
12. Brown A J, Goldsworthy S M, Barnes A A, Eilert M M, Tcheang L, Daniels D, & Dowell S J (2003). The Orphan G protein-coupled receptors GPR41 and GPR43 are activated by propionate and other short chain carboxylic acids. Journal of Biological Chemistry, 278(13), 11312-11319.
13. Min H K, Kapoor A, Fuchs M, Mirshahi F, Zhou H, Maher J, & Sanyal A J (2012). Increased hepatic synthesis and dysregulation of cholesterol metabolism is associated with the severity of non-alcoholic fatty liver disease. Cell metabolism, 15(5), 665-674.
14. Targher G, Bertolini L, Padovani R, Rodella S, Tessari R, Zenari L, & Arcaro G (2007). prevalence of non-alcoholic fatty liver disease and its association with cardiovascular disease among type 2 diabetic patients. Diabetes care, 30(5), 1212-1218.
15. Mahlapuu M, Caputo M, Xia Y, & Cansby E (2022). GCKIII kinases in lipotoxicity: Roles in NAFLD and beyond. Hepatology Communications, 6(10), 2613-2622.
16. Mofrad P, Contos M J, Haque M, Sargeant C, Fisher R A, Luketic V A, & Sanyal A J (2003). Clinical and histologic spectrum of non-alcoholic fatty liver disease associated with normal ALT values. Hepatology, 37(6), 1286-1292.
17. NOGUCHI H, TAZAWA Y, NISHINOMIYA F, & TAKADA G (1995). The relationship between serum transaminase activities and fatty liver in children with simple obesity. Pediatrics International, 37(5), 621-625.
18. Hernaez R, Lazo M, Bonekamp S, Kamel I, Brancati F L, Guallar E, & Clark J M (2011). Diagnostic accuracy and reliability of ultrasonography for the detection of fatty liver: a meta‐analysis. Hepatology, 54(3), 1082-1090.
19. Di Martino M, Koryukova K, Bezzi M, & Catalano C (2017). Imaging features of non-alcoholic fatty liver disease in children and adolescents. Children, 4(8), 73.
20. Borra R J, Salo S, Dean K, Lautamaki R, Nuutila P, Komu M, & Parkkola R (2009). Non-alcoholic fatty liver disease: rapid evaluation of liver fat content with in-phase and out-of-phase MR imaging. Radiology, 250(1), 130-136.
21. Chartampilas E (2018). Imaging of non-alcoholic fatty liver disease and its clinical utility. Hormones, 17(1), 69-81.
22. Ekstedt M, Franzén L E, Mathiesen U L, Thorelius L, Holmqvist M, Bodemar G, & Kechagias S (2006). Long‐term follow‐up of patients with NAFLD and elevated liver enzymes. Hepatology, 44(4), 865-873.
23. Kang S H, Lee H W, Yoo J J, Cho Y, Kim S U, Lee T H, & Cho Y K (2021). KASL clinical practice guidelines: Management of non-alcoholic fatty liver disease. Clinical and molecular hepatology, 27(3), 363.
24. Rinella M E, Neuschwander-Tetri B A, Siddiqui M S, Abdelmalek M F, Caldwell S, Barb D, & Loomba R (2023). AASLD practice guidance on the clinical assessment and management of non-alcoholic fatty liver disease. Hepatology, 10-1097.