Non-alcoholic fatty liver disease in adults 2021: A clinical practice guideline of the Italian Association for the Study of the Liver (AISF), the Italian Society of Diabetology (SID) and the Italian Society of Obesity (SIO)

Abstract

Nonalcoholic fatty liver disease (NAFLD) is a common and emerging liver disease in adults, paralleling the epidemic of obesity and diabetes and leading to worrisome events (hepatocellular carcinoma and end-stage liver disease). In the past years, mounting evidence added insights about epidemiology, natural history, diagnosis and lifestyle-based or drug treatment of NAFLD. In this rapidly evolving scenario, members of the Associazione Italiana per lo Studio del Fegato, the Società Italiana di Diabetologia and the Società Italiana dell'Obesità reviewed current knowledge on NAFLD. The quality of the published evidence is graded, and practical recommendations are made following the rules and the methodology suggested in Italy by the Centro Nazionale per l'Eccellenza delle cure and Istituto Superiore di Sanità. Whenever possible, recommendations are placed within the context the Italian Healthcare system, with reference to specific experience and local diagnostic and management resources. Level of evidence Level of evidence of recommendations for each PICO question were reported according to available evidence.

Osteosarcopenia in NAFLD/MAFLD: An Underappreciated Clinical Problem in Chronic Liver Disease

“…Metformin is an insulin sensitiser drug widely used for treating type 2 diabetes; it is safe for the liver but not specifically recommended to treat NAFLD [ 254 , 255 ]. Currently, it is being investigated as a potential anti-sarcopenic agent.…”

SGLT2 Inhibitors as the Most Promising Influencers on the Outcome of Non-Alcoholic Fatty Liver Disease

“…More recently, both the EASL and AISF guidelines suggest that the combined association between elastography and serum markers, such as Fibrosis-4 index (Fib-4) and NAFLD fibrosis score (NFS), allows the accurate definition of the risk of fibrosis and may be useful in selecting subjects to be biopsied [ 1 , 2 ].…”

“…The defining feature of NAFL in histology is the presence of at least 5% of lipids within hepatic cells, in the absence of evidence of hepatocellular damage [ 1 ], which is not linked to alcohol or drug abuse or other conditions that can cause liver steatosis. NASH is also defined as the presence of at least 5% of lipids within hepatic cells but in association with signs of inflammation and hepatocellular damage, with or without fibrosis, and which can progress toward liver cirrhosis, liver failure, or the development of hepatocellular carcinoma (HCC) [ 2 ].…”

Зміни Довжини Теломер Ясен В Осіб Із Неалкогольною Жировою Хворобою Печінки

“…Особливу увагу насьогодні зосереджують на хворобах обміну речовин і, насамперед, неалкогольній жировій хворобі печінки (НАЖХП). Ця соматична хвороба спочатку характеризується накопиченням жиру в гепатоцитах, що під впливом оксидативного стресу та цитокінів переходить в хронічний запальний процес -неалкогольний стеатогепатит [10]. Також, науковий інтерес викликає не тільки стан тканин пародонта хворих на НАЖХП, а й їх подружжя, які хоча і не мають зазначеної хвороби, але мають ряд загальних факторів ризику, а саме харчові звички, відношення до принципів індивідуальної гігієни порожнини рота та інші.…”