Management of Nonalcoholic Fatty Liver Disease

Afdhal, Nezam H.

doi:10.1001/jama.2012.8402

Cited by 19 publications

(10 citation statements)

References 71 publications

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“…4G and H). In human cases, NASH is diagnosed histopathologically using the NAFLD Activity Score (NAS) [1, 12]. In this experimental model, LH-H mice demonstrated moderate steatosis (score 2), prominent ballooning (score 2), and severe lobular inflammation (score 3), for a total NAS score of 7.…”

Section: Resultsmentioning

confidence: 99%

Fibroblast Growth Factor-5 Participates in the Progression of Hepatic Fibrosis

et al. 2014

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Non-alcoholic steatohepatitis (NASH) is characterized by the presence of steatosis, inflammation, and fibrosis and is believed to develop via a “two-hit process”; however, its pathophysiology remains unclear. Fibroblast growth factors (FGFs) are heparin-binding polypeptides with diverse biological activities in many developmental and metabolic processes. In particular, FGF5 is associated with high blood pressure. We investigated the function of FGF5 in vivo using spontaneously Fgf5 null mice and explored the role of diet in the development of NASH. Mice fed a high-fat diet gained little weight and had higher serum alanine transaminase, aspartate amino transferase, and non–high-density lipoprotein-cholesterol levels. Liver histology indicated marked inflammation, focal necrosis, fat deposition, and fibrosis, similar to the characteristics of NASH. FGF5 and a high-fat diet play significant roles in the pathophysiology of hepatic fibrosis and Fgf5 null mice may provide a suitable model for liver fibrosis or NASH.

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Section: Resultsmentioning

confidence: 99%

Fibroblast Growth Factor-5 Participates in the Progression of Hepatic Fibrosis

et al. 2014

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“…Considering the clinical impact of NAFLD on public health, and its high prevalence, timely screening and detection could be essential to avoid further NAFLD-related morbidity, reduce healthcare costs, and promote early lifestyle interventions that may prevent or delay deterioration of the disease [12]. As NAFLD is usually asymptomatic, it is difficult to predict or determine whether individuals have NAFLD in community settings.…”

Section: Introductionmentioning

confidence: 99%

Non–Laboratory-Based Self-Assessment Screening Score for Non-Alcoholic Fatty Liver Disease: Development, Validation and Comparison with Other Scores

Lee

Bang

Park³

et al. 2014

PLoS ONE

102

110

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BackgroundNon-alcoholic fatty liver disease (NAFLD) is a prevalent and rapidly increasing disease worldwide; however, no widely accepted screening models to assess the risk of NAFLD are available. Therefore, we aimed to develop and validate a self-assessment score for NAFLD in the general population using two independent cohorts.MethodsThe development cohort comprised 15676 subjects (8313 males and 7363 females) who visited the National Health Insurance Service Ilsan Hospital in Korea in 2008–2010. Anthropometric, clinical, and laboratory data were examined during regular health check-ups and fatty liver diagnosed by abdominal ultrasound. Logistic regression analysis was conducted to determine predictors of prevalent NAFLD and to derive risk scores/models. We validated our models and compared them with other existing methods using an external cohort (N = 66868).ResultsThe simple self-assessment score consists of age, sex, waist circumference, body mass index, history of diabetes and dyslipidemia, alcohol intake, physical activity and menopause status, which are independently associated with NAFLD, and has a value of 0–15. A cut-off point of ≥8 defined 58% of males and 36% of females as being at high-risk of NAFLD, and yielded a sensitivity of 80% in men (77% in women), a specificity of 67% (81%), a positive predictive value of 72% (63%), a negative predictive value of 76% (89%) and an AUC of 0.82 (0.88). Comparable results were obtained using the validation dataset. The comprehensive NAFLD score, which includes additional laboratory parameters, has enhanced discrimination ability, with an AUC of 0.86 for males and 0.91 for females. Both simple and comprehensive NAFLD scores were significantly increased in subjects with higher fatty liver grades or severity of liver conditions (e.g., simple steatosis, steatohepatitis).ConclusionsThe new non–laboratory-based self-assessment score may be useful for identifying individuals at high-risk of NAFLD. Further studies are warranted to evaluate the utility and feasibility of the scores in various settings.

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“…Patients with NASH have an increased mortality of 35% to 85% (controlled for age and gender). 52 Cirrhosis occurs as the major risk factor, with 38% to 45% of adults with NASH developing liver failure over 7 to 10 years. 52 Factors for the progression to cirrhosis include insulin resistance, alterations in liver fat metabolism, systemic inflammation, and oxidative stress (from diet, environment, infection, drugs, and/or toxins).…”

Section: Clinical Featuresmentioning

confidence: 99%

“…52 Cirrhosis occurs as the major risk factor, with 38% to 45% of adults with NASH developing liver failure over 7 to 10 years. 52 Factors for the progression to cirrhosis include insulin resistance, alterations in liver fat metabolism, systemic inflammation, and oxidative stress (from diet, environment, infection, drugs, and/or toxins). 33 Causes of death in patients with NASH include sepsis, portal hypertension with variceal hemorrhage, hepatocellular carcinoma, cardiovascular disease– related mortality, and liver mortality, which is increased 9- to 10-fold.…”

Section: Clinical Featuresmentioning

confidence: 99%

“…33 Causes of death in patients with NASH include sepsis, portal hypertension with variceal hemorrhage, hepatocellular carcinoma, cardiovascular disease– related mortality, and liver mortality, which is increased 9- to 10-fold. 52 Given the high rate of morbidity and mortality over time, NAFLD, as other chronic diseases, incurs great psychological, behavioral, and pharmacological costs in quality of life. 16 This further underscores the need for investigations into its etiology, and potential interventions.…”

Section: Clinical Featuresmentioning

confidence: 99%

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