Evidence-based clinical practice guidelines for nonalcoholic fatty liver disease/nonalcoholic steatohepatitis

Abstract

Nonalcoholic fatty liver disease (NAFLD) is currently the most common cause of chronic liver disease in industrialized countries worldwide, and has become a serious public health issue not only in Western countries but also in many Asian countries including Japan. Within the wide spectrum of NAFLD, nonalcoholic steatohepatitis (NASH) is a progressive form of disease, which often develops into liver cirrhosis and increases the risk of hepatocellular carcinoma. In turn, a large proportion of NAFLD/NASH is the liver manifestation of metabolic syndrome, suggesting that NAFLD/NASH plays a key role in the pathogenesis of systemic atherosclerotic diseases. Currently, a definite diagnosis of NASH requires liver biopsy, though various noninvasive measures are under development. The mainstays of prevention and treatment of NAFLD/NASH include dietary restriction and exercise; however, pharmacological approaches are often necessary.Currently, vitamin E and thiazolidinedione derivatives are the most evidence-based therapeutic options, although the clinical evidence for long-term efficacy and safety is limited. This practice guideline for NAFLD/NASH, established by the Japanese Society of Gastroenterology in cooperation with The Japan Society of Hepatology, covers lines of clinical evidence reported internationally in the period starting from 1983 to January 2012, and each clinical question was evaluated using the GRADE system. Based on the primary release of the full version in Japanese, this English summary provides the core essentials of this clinical practice guideline comprising the definition, diagnosis, and current therapeutic recommendations for NAFLD/NASH in Japan.

Human liver epigenetic alterations in non-alcoholic steatohepatitis are related to insulin action

“…1,[5][6][7] Therefore, epigenetic modifications, either inherited or induced by lifestyles, 8,9 may play a key role in the pathogenesis of the disease. To some extent, the epigenetic mechanisms resulting in aberrant histone modifications, differences in DNA methylation, and dysregulation of microRNAs are the ones that have been related to NAFLD and its transition to more advanced stages.…”

Effects of canagliflozin, an SGLT2 inhibitor, on hepatic function in Japanese patients with type 2 diabetes mellitus: pooled and subgroup analyses of clinical trials

“…Cusi et al recently reported on the beneficial effects of pioglitazone on NASH in patients with prediabetes or type 2 diabetes mellitus [15]. However, the only established therapies for NAFLD are dietary and exercise therapies [1,2].…”

“…Nonalcoholic fatty liver disease (NAFLD), which is the most common chronic liver disease worldwide, is classified into nonalcoholic fatty liver (NAFL) and nonalcoholic steatohepatitis (NASH) [1,2]. The prevalence of NAFLD has increased with the rise in obesity and metabolic syndrome and is associated with lifestyle changes.…”

Usefulness of Magnetic Resonance Imaging for the Diagnosis of Hemochromatosis with Severe Hepatic Steatosis in Nonalcoholic Fatty Liver Disease

“…NAFLD includes non-alcoholic fatty liver (NAFL) and non-alcoholic steatohepatitis (NASH), with NAFL representing the first phase of NASH. NASH, which is characterized by steatosis, can subsequently develop into fatty liver disease with associated inflammation, with the potential to result in cirrhosis and/or hepatocellular carcinoma (3). The increased number of young patients with NAFLD/NASH associated with metabolic syndrome has therefore become an important epidemiologic problem (1).…”