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Abstract Details
NAFLD as a metabolic disease in humans: A literature review
Diabetes Obes Metab. 2021 Jan 19. doi: 10.1111/dom.14322. Online ahead of print.
Bertrand Cariou1, Christopher D Byrne2, Rohit Loomba3, Arun J Sanyal4
Author information
1L'institut du thorax, Department of Endocrinology, UNIV Nantes, Inserm, CNRS, CHU Nantes, Nantes, France.
2Endocrinology and Metabolism, Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK; Southampton National Institute for Health Research, Biomedical Research Centre, University Hospital Southampton, UK.
3NAFLD Research Center, Division of Gastroenterology, University of California, San Diego, USA.
4Department of Internal Medicine, Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University, Richmond, USA.
Abstract
Aims: Non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) are becoming recognised as hepatic manifestations of metabolic syndrome, closely linked to visceral obesity, insulin resistance and type 2 diabetes. A systematic literature review was conducted to identify recent epidemiological, biomarker, genetic and clinical evidence that expands our understanding of NAFLD as a metabolic disorder.
Materials and methods: Literature search using PubMed to identify trials, observational studies and meta-analyses published in the past 5 years.
Results: 95 publications met pre-specified inclusion criteria and reported on the interplay between NAFLD/NASH and metabolic dysfunction, in terms of disease burden and/or epidemiology (n=10), pathophysiology, risk factors and associated conditions (n=29), diagnosis and biomarkers (n=34), and treatment approaches (n=22). There is a growing body of evidence on the links between NAFLD/NASH pathogenesis and mechanisms of metabolic dysfunction, through liver lipid accumulation, insulin resistance, inflammation, apoptosis, and fibrogenic remodelling within the liver. The frequent co-occurrence of NAFLD with obesity, metabolic syndrome and type 2 diabetes supports this premise. Therapeutic approaches originally envisaged for type 2 diabetes or obesity (such as glucagon-like peptide-1 receptor agonists, sodium-glucose co-transporter-2 inhibitors, insulin sensitizers, and bariatric surgery) have shown promising signs of benefit for patients with NAFLD/NASH.
Conclusions: Given the complex interplay between NAFLD and metabolic dysfunction, there is an urgent need for multidisciplinary collaboration and established protocols for care of patients with NAFLD that are individualized and ideally support reduction of overall metabolic risk as well as treatment for NASH.