Fatty Liver and Nonalcoholic Steatohepatitis. Where Do We Stand and Where Are We Going?

Abstract

Background: Fatty liver (FL) is the most common liver disease but its clinical significance remains elusive. Nonalcoholic steatohepatitis (NASH) is increasingly recognized as a cause of liver failure, sometimes recurring following transplantation. Recent data on both conditions are critically reviewed. Methods: A Medline search of the medical literature (1990 to September 1998) and cross-references was performed. Results: FL most commonly affects middle-aged men with obesity, altered glucose metabolism, hyperlipidemia, and hypertension. The link between biology of HCV, iron metabolism and FL should be addressed. Prospective studies should also quantify the rate and the factors involved in the progression of FL to NASH. The clinical spectrum of NASH is currently broader than it was initially recognized. Diagnosis of FL and NASH may involve ultrasonography, liver biopsy, and recognition of related conditions. Treatment of these conditions must be tailored according to patient’s features. Conclusions: The clinical significance of FL is incompletely understood at present. The relationship, if any, of FL and the metabolic syndrome should be carefully investigated.

Review article: hepatic steatosis and insulin resistance

“…However, examples from the animal world have led to the speculation that they might represent an adaptive response to anticipated food shortage. 3,4 Therefore, HS has recently been proposed to represent the liver counterpart of the 'thrifty genotype' 5 but it may also herald ominous biological and clinical consequences in humans. Aim of the present reappraisal is to update relevant issues of HS and IR that have come to the light following the conference held in Den Haag in 2000.…”

“…3 However, the biological rationale for such 5% cut-off has recently been challenged. Indeed a Finnish study reported that 50% of 30 normal men had, on average, only 1.7 ± 0.2% of liver fat content as evaluated through proton spectroscopy.…”

“…15 It is concluded that the prevalence of HS and that of IR are in the same order of magnitude, which is a further evidence for their non-chance association. 3 …”

Should Nonalcoholic Fatty Liver Disease Be Renamed?

“…In conclusion, a large body of evidence [8,38,39,51,52,61,[113][114][115][116] defi nitely supports the pathogenic role of IR in NAFLD and includes this condition within the boundaries of the MS.…”

“…The liver appears to be a target organ of a disease (the MS) which is systemic in nature and therefore carries implications for both hepatic and extrahepatic manifestations and complications [51,61] ( fi g. 1 ).…”