Histopathology of nonalcoholic fatty liver disease

Brunt, Elizabeth M.

doi:10.3748/wjg.v16.i42.5286

Cited by 341 publications

(323 citation statements)

References 149 publications

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“…While the majority of uncomplicated steatosis is non-progressive, approximately 20%-30% of patients will develop nonalcoholic steatohepatitis (NASH), a more aggressive necro-inflammatory phenotype associated with increased risk for advanced fibrosis predisposing towards cirrhosis, portal hypertension, decompensated liver failure and hepatocellular carcinoma [7,8] . The pathological evaluation and classification of biopsied liver tissue remains the definitive standard investigation whereby a suspected diagnosis of NAFLD is confirmed and histological severity quantified to assist prognostication and the selection of appropriate therapeutic intervention [9] . This approach is to an extent advantageous as it allows for the concurrent assessment of multiple histological parameters and may help identify unexpected hepatic pathology or comorbidities.…”

Section: Introductionmentioning

confidence: 99%

Composite prognostic models across the non-alcoholic fatty liver disease spectrum: Clinical application in developing countries

Luckhoff

Kruger

Kotze

2015

WJH

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Heterogeneity in clinical presentation, histological severity, prognosis and therapeutic outcomes charac teristic of nonalcoholic fatty liver disease (NAFLD) necessitates the development of scientifically sound classification schemes to assist clinicians in stratifying patients into meaningful prognostic subgroups. The need for replacement of invasive liver biopsies as the standard method whereby NAFLD is diagnosed, graded and staged with biomarkers of histological severity injury led to the development of composite prognostic models as potentially viable surrogate alternatives. In the present article, we review existing scoring systems used to (1) confirm the presence of undiagnosed hepatosteatosis; (2) distinguish between simple steatosis and NASH; and (3) predict advanced hepatic fibrosis, with particular emphasis on the role of NAFLD as an independent cardiometabolic risk factor. In addition, the incorporation of functional genomic markers and application of emerging imaging technologies are discussed as a means to improve the diagnostic accuracy and predictive performance of promising composite models found to be most appropriate for widespread clinical adoption. Composite prognostic models across the non-alcoholic fatty liver disease spectrum: Clinical application in developing countries have entered the clinical domain as potentially viable alternatives. Lifestylebased intervention remains the cornerstone of treatment in patients with NAFLD. The widespread clinical adoption of composite diagnostic and predictive models could however prove useful in informing clinical and therapeutic decision making with the goal of adding value to patient care across the NAFLD spectrum.Lückhoff HK, Kruger FC, Kotze MJ. Composite prognostic models across the non-alcoholic fatty liver disease spectrum:

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Section: Introductionmentioning

confidence: 99%

Composite prognostic models across the non-alcoholic fatty liver disease spectrum: Clinical application in developing countries

Luckhoff

Kruger

Kotze

2015

WJH

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“…In addition to macrovacuolar steatosis, NASH is characterized by microvesicular steatosis, inflammation, fibrosis, and the presence of hepatocyte injury in the forms of ballooning and apoptosis. 1,2 Even though NASH is not by itself a severe hepatic lesion, it can progress to cirrhosis and liver cancer. 3 Collectively, the large spectrum of conditions ranging from fatty liver to NASH is referred to as nonalcoholic liver disease (NAFLD).…”

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confidence: 99%

Mitochondrial adaptations and dysfunctions in nonalcoholic fatty liver disease

Massart²,

et al. 2013

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The worldwide epidemic of obesity and insulin resistance favors nonalcoholic fatty liver disease (NAFLD). Insulin resistance (IR) in the adipose tissue increases lipolysis and the entry of nonesterified fatty acids (NEFAs) in the liver, whereas IR‐associated hyperinsulinemia promotes hepatic de novo lipogenesis. However, several hormonal and metabolic adaptations are set up in order to restrain hepatic fat accumulation, such as increased mitochondrial fatty acid oxidation (mtFAO). Unfortunately, these adaptations are usually not sufficient to reduce fat accumulation in liver. Furthermore, enhanced mtFAO without concomitant up‐regulation of the mitochondrial respiratory chain (MRC) activity induces reactive oxygen species (ROS) overproduction within different MRC components upstream of cytochrome c oxidase. This event seems to play a significant role in the initiation of oxidative stress and subsequent development of nonalcoholic steatohepatitis (NASH) in some individuals. Experimental investigations also pointed to a progressive reduction of MRC activity during NAFLD, which could impair energy output and aggravate ROS overproduction by the damaged MRC. Hence, developing drugs that further increase mtFAO and restore MRC activity in a coordinated manner could ameliorate steatosis, but also necroinflammation and fibrosis by reducing oxidative stress. In contrast, physicians should be aware that numerous drugs in the current pharmacopoeia are able to induce mitochondrial dysfunction, which could aggravate NAFLD in some patients. (Hepatology 2013;58:1497–1507)

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“…Histology is probably at present the gold standard for evaluating fat liver, but liver biopsies are quite an invasive procedure, therefore strict criteria are imposed in our Unit, trunk fat > 40%, raised AST, ALT and gamma GT and fasting insulinemia >15 uU/ml. The rationale for liver biopsy and a complete histopathologic description and evaluation can be found elsewhere [53].…”

Section: Fatty Liver Disease Among Other Comorbidities Requiring Earlmentioning

confidence: 99%

Fatty Liver Disease among other Comorbidities Requiring Early Diagnosis in Pediatric Obesity

Benavent

Juste²

2013

OCTOA

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Histopathology of nonalcoholic fatty liver disease

Cited by 341 publications

References 149 publications

Composite prognostic models across the non-alcoholic fatty liver disease spectrum: Clinical application in developing countries

Composite prognostic models across the non-alcoholic fatty liver disease spectrum: Clinical application in developing countries

Mitochondrial adaptations and dysfunctions in nonalcoholic fatty liver disease

Fatty Liver Disease among other Comorbidities Requiring Early Diagnosis in Pediatric Obesity

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