Evolution of NAFLD and Its Management

Abstract

The global prevalence of nonalcoholic fatty liver disease (NAFLD) is estimated to be 25% and continues to rise worldwide in the setting of the obesity epidemic. This increase is especially concerning because NAFLD is often a progressive disease that can be associated with significant complications such as liver cirrhosis, hepatocellular carcinoma, and an increase in liver-related and overall mortality. Because of the devastating complications and comorbidities, NAFLD is a very costly disease for the healthcare system, with estimated annual direct medical costs exceeding $100 billion in the United States alone. Given this progressive course, it is imperative to make the diagnosis in patients with risk factors (metabolic syndrome, weight gain, and insulin resistance/diabetes). Once the diagnosis is made, the focus should shift to treatment and monitoring for the development of associated complications. Given that currently no pharmaceutical intervention is approved for the treatment of NAFLD, focus shifts instead to mitigation of risk factors through avoidance of foods that are rich in red meat, trans fats, refined carbohydrates, and high-fructose corn syrup; are low fiber; and have high energy density. The landmark of treatment, however, continues to be weight loss and improvement of insulin resistance, often through a multimodality approach. The current manuscript reviews the clinical phenotypes of NAFLD, its risk factors, and pathogenesis, as well as treatment options including lifestyle modifications and dietary interventions, medical therapies, endoscopic bariatric interventions, and bariatric surgery. (Nutr Clin Pract. 2020;35:72-84) Keywords fatty liver; insulin resistance; liver cirrhosis; non-alcoholic fatty liver disease; nutrition therapy; weight loss From the

Protective effect of lyophilized sapodilla (Manilkara zapota) fruit extract against CCl4-induced liver damage in rats

“…This disease is a major cause of elevation of liver enzymes. The global prevalence of NAFLD is about 25% and continues to raise worldwide ( Mundi et al, 2019 ). A recent Swiss study has reported that the incidence of advanced liver disease is estimated to increase by approximately 40% by 2030 ( Goossens et al, 2019 ).…”

Integrative Management of Metabolic Syndrome in Youth Prescribed Second-Generation Antipsychotics

“…Youth who adhere the closest to a Mediterranean diet have lower rates of obesity and MetS [ 45 , 46 ]. The Mediterranean diet can be a helpful intervention in the treatment of non-alcoholic fatty liver disease (NAFLD) [ 47 ]. For younger children, using a traffic light dietary pattern may be helpful in dividing foods into “green light” (fruits, vegetables), “yellow light” (grains), and “red light” (least nutrient-dense, highest calories), and limiting “red light” foods to a certain number per week may be helpful [ 48 ].…”

“…Increased fiber consumption is linked to improved insulin sensitivity and to lower hemoglobin A1c percentages in patients with diabetes and pre-diabetes [ 51 ]. An increase in dietary fiber is one of the first-line interventions in the treatment of NAFLD as well [ 47 ]. For children, to calculate the recommended daily fiber intake, clinicians can use the “age plus 5” formula [ 48 ].…”

Insights Into Extracellular Vesicles as Biomarker of NAFLD Pathogenesis

“…The classic definition of NAFLD excludes excessive alcohol consumption, which is well known to cause alcoholic liver disease. Growing evidences support the hypothesis that NAFLD is the hepatic manifestation of metabolic syndrome, with insulin resistance as the common pathogenic factor (4). Although some genetic risk factors have been reported (5), the increase in body weight and the presence of several hallmarks of metabolic syndrome such as adiposity, hyperglycemia, dyslipidemia, and hypertension, may be key determinants in the pathogenesis of NAFLD.…”