Background: It is estimated that around 70% of Type 2 Diabetes Mellitus patients (T2DM) have Non-Alcoholic Fatty Liver Disease (NAFLD). Awareness and education are amongst the major shortcomings of the public health response to the increasing threat of NAFLD. Characterizing the specific NAFLD-related information needs of particular high-risk metabolic communities, for instance, T2DM patients, might aid in the development of evidencebased health promotion strategies, ultimately promoting NAFLD-awareness, treatment adherence and therapeutic success rates. Methods: Semi-structured interviews with T2DM patients were conducted to gain insight into their awareness of NAFLD, including its relationship with insulin resistance and T2DM. Results: Awareness of NAFLD as a disease entity, as well as its progression to end-stage liver disease or its relationship with other metabolic conditions, including insulin resistance and T2DM was low. Surveillance behaviours were also suboptimal and perceptions on the self-management knowledge and praxis regarding lifestyle intervention components of T2DM treatment seemed detached from those of NAFLD. Conclusions: Our findings could inform the integration of NAFLD-related content in T2DM health promotion strategies. Rising awareness on NAFLD progression and its relationship with T2DM using culturally and communityrelevant constructs might facilitate the development of primary and secondary prevention programmes to promote the adherence to lifestyle interventions by influencing NAFLD threat perceptions.

Mitochondria play a central role in non-alcoholic fatty liver disease (NAFLD) progression and in the control of cell death signalling during the progression to hepatocellular carcinoma (HCC). Associated with the metabolic syndrome, NAFLD is mostly driven by insulin-resistant white adipose tissue lipolysis that results in an increased hepatic fatty acid influx and the ectopic accumulation of fat in the liver. Upregulation of beta-oxidation as one compensatory mechanism leads to an increase in mitochondrial tricarboxylic acid cycle flux and ATP generation. The progression of NAFLD is associated with alterations in the mitochondrial molecular composition and respiratory capacity, which increases their vulnerability to different stressors, including calcium and pro-inflammatory molecules, which result in an increased generation of reactive oxygen species (ROS) that, altogether, may ultimately lead to mitochondrial dysfunction. This may activate further pro-inflammatory pathways involved in the progression from steatosis to steatohepatitis (NASH). Mushroom-enriched diets, or the administration of their isolated bioactive compounds, have been shown to display beneficial effects on insulin resistance, hepatic steatosis, oxidative stress, and inflammation by regulating nutrient uptake and lipid metabolism as well as modulating the antioxidant activity of the cell. In addition, the gut microbiota has also been described to be modulated by mushroom bioactive molecules, with implications in reducing liver inflammation during NAFLD progression. Dietary mushroom extracts have been reported to have anti-tumorigenic properties and to induce cell-death via the mitochondrial apoptosis pathway. This calls for particular attention to the potential therapeutic properties of these natural compounds which may push the development of novel pharmacological options to treat NASH and HCC. We here review the diverse effects of mushroom-enriched diets in liver disease, emphasizing those effects that are dependent on mitochondria.

This is an open access article under the terms of the Creat ive Commo ns Attri butio n-NonCo mmerc ial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Comics can be an effective tool to communicate health information and appeal to behavior change. The aim of this project, undertaken by a multidisciplinary team, was to develop a comic to raise awareness about non-alcoholic fatty liver disease (NAFLD) and promote healthy lifestyles regarding dietary practices and regular physical activity patterns. We focused on the ability of comics in portraying abstract concepts to articulate NAFLD biomedical knowledge and use it as an encouragement/empowerment strategy towards disease-related beliefs, attitudes, intentions and behaviors. Formative research by means of a NAFLD awareness study with T2DM patients informed the selection of biomedical content and the design of characters and storylines on which the former was embedded. Mindful of graphic narrative and storytelling as a valuable tool in the domains of health promotion, disease prevention and therapeutic adherence, this work discusses the decisions that were taken for the materialization of the comic ‘A healthy liver will always deliver!’.

Sabe o que é o fígado? Conhece as muitas coisas importantes que faz, mantendo-nos vivos e saudáveis? Sabia que os hábitos alimentares podem afetar o bem-estar de nosso fígado? Ou que um estilo de vida sedentário pode prejudicá-lo? Provavelmente não sabe, mas uma em cada quatro pessoas no mundo tem Doença do Fígado Gordo Não Alcoólico (FIGNA; NAFLD na sigla inglesa), que pode passar despercebida por muito anos, e resultar em danos graves ao fígado, incluindo cirrose e cancro. Será que é uma dessas pessoas? O acumular excessivo de gordura no fígado é causado por dietas pouco saudáveis e estilos de vida sedentários. Acha que pode estar em risco? Embora estes problemas possam existir em pessoas com um peso ideal, a obesidade e a diabetes de tipo 2 são fatores de risco para o desenvolvimento de FIGNA. Então como podemos resolver isto? Conheça melhor o seu fígado com esta banda desenhada, e descubra como tratar e prevenir esta forma de doença hepática! Pense no seu fígado da próxima vez que comer, e não se esqueça de o ajudar, mantendo um estilo de vida ativo. Lembre-se que um fígado equilibrado é meio caminho andado!