AISF position paper on nonalcoholic fatty liver disease (NAFLD): Updates and future directions

Abstract

This review summarizes our current understanding of nonalcoholic fatty liver disease (NAFLD), a multi-factorial systemic disease resulting from a complex interaction between a specific genetic background and multiple environmental/metabolic "hits". The role of gut microbiota, lipotoxicity, inflammation and their molecular pathways is reviewed in-depth. We also discuss the epidemiology and natural history of NAFLD by pinpointing the remarkably high prevalence of NAFLD worldwide and its inherent systemic complications: hepatic (steatohepatitis, advanced fibrosis and cirrhosis), cardio-metabolic (cardiovascular disease, cardiomyopathy, arrhythmias and type 2 diabetes) and neoplastic (primary liver cancers and extra-hepatic cancers). Moreover, we critically report on the diagnostic role of non-invasive biomarkers, imaging techniques and liver biopsy, which remains the reference standard for diagnosing the disease, but cannot be proposed to all patients with suspected NAFLD. Finally, the management of NAFLD is also reviewed, by highlighting the lifestyle changes and the pharmacological options, with a focus on the innovative drugs. We conclude that the results of ongoing studies are eagerly expected to lead to introduce into the clinical arena new diagnostic and prognostic biomarkers, prevention and surveillance strategies as well as to new drugs for a tailored approach to the management of NAFLD in the individual patient.

Glucagon‐like peptide‐1 receptor agonists for antipsychotic‐associated cardio‐metabolic risk factors: A systematic review and individual participant data meta‐analysis

“…We were not able to include data on non‐alcoholic fatty liver disease (NAFLD). NAFLD is a precursor for the development of incident type 2 diabetes and metabolic syndrome and has a mutual and bi‐directional relationship with these disease entities . There is recent evidence for the efficacy of liraglutide for non‐alcoholic steatohepatitis .…”

“…NAFLD is a precursor for the development of incident type 2 diabetes and metabolic syndrome 57 and has a mutual and bi- Forest plot of standardized mean difference of metabolic variables by antipsychotic directional relationship with these disease entities. 58 There is recent evidence for the efficacy of liraglutide for non-alcoholic steatohepatitis. 59 Future studies of GLP-1RAs should include measures of NAFLD.…”

Complement C3 and fatty liver disease in Rheumatoid arthritis patients: a cross-sectional study

“…However, the relationship between NAFLD and obesity is already well-established in the literature [9]. However, the relationship between NAFLD and obesity is already well-established in the literature [9].…”

“…Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in the Western countries [8] and develops in strict association with cardiometabolic diseases, including T2D and the Metabolic Syndrome (MS) [9]. The spectrum of NAFLD ranges from the most benign formliver steatosisto steatohepatitis and possibly fibrosis and irreversible cirrhosis [8].…”

Effect of cholecystectomy on hepatic fat accumulation and insulin resistance in non-obese Hispanic patients: a pilot study

“…NAFLD is considered both, a metabolic manifestation of MS and in some cases, a primary determinant of insulin resistance (IR) and the metabolic abnormalities clustered in the MS [8–12]. The natural history and possible evolution of NAFLD varies greatly in seriousness, starting as an accumulation of fat in the hepatocyte and potentially evolving towards nonalcoholic steatohepatitis (NASH), cirrhosis and hepatocellular carcinoma [13–15]. …”