Nonalcoholic fatty liver disease and alcoholic liver disease: metabolic diseases with systemic manifestations

Abstract

The progression of liver disease is portrayed by several common, overarching signs and symptoms. Classically, these include findings such as spider angiomata, jaundice, palmar erythema, and as cirrhosis decompensates, ascites, variceal hemorrhage (VH), hepatic encephalopathy (HE), and hepatocellular carcinoma (HCC). Aside from these universal hallmarks among cirrhotics, patients with nonalcoholic fatty liver disease (NAFLD) and alcoholic liver disease (ALD) harbor their own distinct systemic associations and manifestations. NAFLD is tightly linked to metabolic syndrome, which appears to be a driving force for a multitude of comorbidities, such as insulin resistance, cardiovascular disease, chronic kidney disease (CKD), obstructive sleep apnea (OSA), as well as increased malignancy risk. ALD also maintains a variety of comorbidities congruent with systemic effects of chronic alcohol use. These findings are highlighted by cardiovascular conditions, neuronal damage, myopathy, nutritional deficiencies, chronic pancreatitis, in addition to increased malignancy risk. While a general, guideline-driven management for all cirrhotic patients remains imperative for minimizing risk of complications, a tailored treatment strategy is useful for patients with NAFLD and ALD who entertain their own constellation of unique systemic manifestations.

Narrative review of current and emerging pharmacological therapies for nonalcoholic steatohepatitis

“…The association of NAFLD with metabolic syndrome has been firmly established (6). Peripheral insulin resistance, obesity, dyslipidemia, and altered lipid metabolism synergistically catalyze the accumulation of hepatic triglycerides, lipotoxicity, and inflammation necessary for progression to NASH and cirrhosis (7). Oxidative stress due to alterations in free radical and antioxidant activities leads to the abnormal release of cytokines such as tumor necrosis factor-α (TNF-α), C-reactive protein, and interleukin-6.…”

Plasma Krebs Cycle Intermediates in Nonalcoholic Fatty Liver Disease

“…The model takes into consideration multiple factors that may contribute to the disease progress and staging [5]. Indeed, NAFLD is closely associated with metabolic syndrome, inflammation, and mitochondrial dysfunction [4,[6][7][8]. Although the mechanism of mitochondrial dysfunction in NAFLD is still not fully elucidated, multiple studies have demonstrated evidence 2 of 11 of molecular, biochemical, and biophysical mitochondrial abnormalities in NAFLD.…”

Development and validation of a nomogram for predicting the risk of obstructive sleep apnea in patients with type 2 diabetes

“…Although smoking cessation might be expected to improve OSA, the evidence to support this is limited (37); hence, exsmokers may still be at higher risk of OSA. Nonalcoholic fatty liver disease (NAFLD) is closely associated with metabolic syndrome, which appears to be a driving force for a multitude of comorbidities such as insulin resistance and OSA (38). OSA is highly prevalent in patients with metabolic syndrome (39), and an increasing severity of OSA is associated with poorer control of T2DM, hypertension, and dyslipidemia, all of which are components of metabolic syndrome (40).…”