-Context -Non-alcoholic fatty liver disease (NAFLD), hepatic manifestation of metabolic syndrome, has been considered the most common liver disease nowadays, which is also the most frequent cause of elevated transaminases and cryptogenic cirrhosis. The greatest input of fatty acids into the liver and consequent increased beta-oxidation contribute to the formation of free radicals, release of inflammatory cytokines and varying degrees of hepatocytic aggression, whose histological expression may vary from steatosis (HS) to non-alcoholic steatohepatitis (NASH). The differentiation of these forms is required by the potential risk of progression to cirrhosis and development of hepatocellular carcinoma. Objective -To review the literature about the major risk factors for NAFLD in the context of metabolic syndrome, focusing on underlying mechanisms and prevention. Method -PubMed, MEDLINE and SciELO data basis analysis was performed to identify studies describing the link between risk factors for metabolic syndrome and NAFLD. A combination of descriptors was used, non-alcoholic fatty liver disease, non-alcoholic steatohepatitis, metabolic syndrome and risk factors. At the end, 96 clinical and experimental studies, cohorts, meta-analysis and systematic reviews of great impact and scientific relevance to the topic, were selected. Results -The final analysis of all these data, pointed out the central obesity, type 2 diabetes, dyslipidemia and hypertension as the best risk factors related to NAFLD. However, other factors were highlighted, such as gender differences, ethnicity, genetic factors and the role of innate immunity system. How these additional factors may be involved in the installation, progression and disease prognosis is discussed. Conclusion -Risk factors for NAFLD in the context of metabolic syndrome expands the prospects to 1) recognize patients with metabolic syndrome at high risk for NAFLD, 2) elucidate pathways common to other co-morbidities, 3) determine risk factors associated with a worse prognosis, 4) develop therapeutic strategies with goal of reducing risk factors, 5) apply acquired knowledge in public health policies focusing on preventive strategies. HEADINGS -Metabolic syndrome X. Fatty liver, non-alcoholic. Risk factors.

RESUMO: "O papel controvertido da kava (Piper methysticum G. Foster) -Fitoterápico ansiolítico, na hepatite tóxica". Kava é um fi toterápico ansiolítico usado no tratamento da insônia e da ansiedade. Alguns casos de hepatotoxicidade induzida pela kava foram relatados na literatura, levando à proibição do seu uso em muitos países. Clinicamente, o espectro dessas alterações variou de elevações transitórias das enzimas hepáticas, até à falência hepática fulminante e morte. Em alguns casos, realizou-se transplante hepático. Este artigo revisa a literatura atual sobre a hepatite tóxica provavelmente relacionada à kava, discute os possíveis mecanismos responsáveis pela hepatotoxicidade potencialmente grave e descreve alguns aspectos que devem ser considerados quando eventos adversos hepáticos pareçam ser relacionados à administração dessa substância. Conclui-se que a possível toxicidade hepática pela kava ainda deve ser investigada e que algumas medidas antes e durante o seu uso são importantes, dada a possibilidade de disfunção hepática grave. Unitermos:Piper methysticum, Piperaceae, kava, hepatite tóxica. ABSTRACT:Kava is an anxiolytic herbal medicine used in the treatment of sleep and anxiety disorders. Some cases of kava-induced hepatotoxicity have been reported in the literature leading to its banishment in most countries worldwide. Clinically, the spectrum ranged from transient elevations of liver enzyme levels to fulminant liver failure and death. Liver transplantation was performed in a few cases. This paper provides a review of the currently available literature on kava-related toxic hepatitis which may result from its use, discusses the possible mechanisms for the potentially severe hepatotoxicity and describes some features which must be considered when adverse liver effects seem to be associated to kava administration. In conclusion, the incidence of kava toxicity on the liver remains to be investigated; however, some concerns before or during kava use are important, due to the possibility of severe liver dysfunction.

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The aim of the present work was to develop a biochemical, histologic and immunohistochemical study about the potential hepatotoxic effect of d-limonene – a component of volatile oils extracted from citrus plants. Blood alkaline phosphatase (ALP), aspartate aminotransferase (AST) and alanine aminotransferase (ALT) from d-limonene-treated animals were determined and compared to morphologic hepatic lesions in order to investigate the possible physiopathologic mechanisms involved in the liver toxicity, in experimental animals treated with d-limonene. Wistar rats were randomly divided into seven groups: two control groups (untreated or receiving only vehicle, tween-80); one positive control (vehicle); two experimental groups treated with d-limonene at doses of 25 mg/kg/day and 75 mg/kg/day for 45 days, and two other groups treated with the same doses for 30 days and kept under observation during 30 more days. Biochemical data showed significant reduction in ALT levels in the animals treated with 75 mg/kg of d-limonene. Histological analysis revealed some hepatocyte morphological lesions, including hydropic degeneration, microvesicular steatosis and necrosis, Kupffer cell hyperplasia and incipient fibrosis. By immunohistochemistry, influx of T (CD3+) and cytotoxic (CD8+) lymphocytes was observed in the rats treated with d-limonene at both dose levels. In conclusion, it is possible that d-limonene has been directly responsible for hepatic parenchymal and matrix damage following subchronic treatment with d-limonene.

This work presents the observed changes in Wistar rats under long treatment (thirteen weeks) with different oral doses of the ethanolic extract (EE) from Jatropha gossypiifolia L., Euphorbiaceae. The most significant toxic signs indicated a reduction of the activity in the central nervous system and digestive disturbances. The histopathological analysis shows hepatotoxity and pulmonary damages. The lethality was 46.6% among males under the higher experimental dose (405 mg/kg) and 13.3% both in females under the higher dose and among the animals treated with 135 mg/kg of the product. These data show the significant oral chronic toxicity of EE of J. gossypiifolia in rats.