medigraphic.com

2018, Number 2

<< Back Next >>

Rev Hosp Jua Mex 2018; 85 (2)

Nonalcoholic fatty liver disease and the work of the internist

Delgado-Cortés HM, García-Juárez FI, García-Juárez I

Language: Spanish
References: 44
Page: 86-93
PDF size: 223.98 Kb.


ABSTRACT

Non-alcoholic fatty liver disease is the reflection of a systemic disease and is currently recognized as the hepatic component of the metabolic syndrome. The prevalence in our environment is not well defined, but a worldwide prevalence of 25.24% has been reported and it has increased in parallel to the obesity epidemic. This entity includes non-alcoholic steatohepatitis, a progressive form of the disease which is associated with cirrhosis and cardiovascular complications. The clinical picture is nonspecific, usually patients are diagnosed in an imaging study indicated for another reason, or referred for the presence of alterations in transaminases. Insulin resistance plays a central role in the pathophysiology and additional mechanisms have been described such as genetic components, race, diet, oxidative stress and intestinal dysbiosis. There are non-invasive methods such as scales and imaging methods to estimate steatosis and liver fibrosis, although the diagnosis of non-alcoholic steatohepatitis continues to be through liver biopsy. Therapeutic options are currently limited, lifestyle modifications with diet and exercise continue to be the mainstay of treatment. Drugs such as pioglitazone and vitamin E have little effectiveness, although new drugs continue to develop. The internist must be familiar with the disease, establish the risk of local complications (fibrosis, cirrhosis, hepatocarcinoma) or systemic (cardiovascular) complications, establish a comprehensive treatment plan and, if necessary, make an early referral to the gastroenterologist.


REFERENCES

  1. Targher G, Day CP, Bonora E. Risk of cardiovascular disease in patients with nonalcoholic fatty liver disease. N Engl J Med 2010; 363(14): 1341-50.

  2. Michelotti GA, Machado MV, Diehl AM. NAFLD, NASH and liver cancer. Nat Rev Gastroenterol Hepatol 2013; 10(11): 656-65.

  3. Reccia I, Kumar J, Akladios C, Virdis F, Pai M, Habib N, et al. Non-alcoholic fatty liver disease: a sign of systemic disease. Metabolism 2017; 72: 94-108.

  4. European Association for the Study of the Liver (EASL), European Association for the Study of Diabetes (EASD), European Association for the Study of Obesity (EASO). EASL-EASD-EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease. J Hepatol 2016; 64(6): 1388-402.

  5. Chalasani N, Younossi Z, Lavine JE, Diehl AM, Brunt EM, Cusi K, et al. The diagnosis and management of non-alcoholic fatty liver disease: practice guideline by the American Gastroenterological Association, American Association for the Study of Liver Diseases, and American College of Gastroenterology. Gastroenterology 2012; 142(7): 1592-609.

  6. Lonardo A, Byrne CD, Caldwell SH, Cortez-Pinto H, Targher G. Global epidemiology of nonalcoholic fatty liver disease: meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology. 2016; 64(4): 1388-9.

  7. López-Velázquez JA, Silva-Vidal KV, Ponciano-Rodríguez G, Chávez-Tapia NC, Arrese M, Uribe M, et al. The prevalence of nonalcoholic fatty liver disease in the Americas. Ann Hepatol 2014; 13(2): 166-78.

  8. Rinella ME. Nonalcoholic fatty liver disease: a systematic review. JAMA 2015; 313(22): 2263-73.

  9. Cheung O, Kapoor A, Puri P, Sistrun S, Luketic VA, Sargeant CC, et al. The impact of fat distribution on the severity of nonalcoholic fatty liver disease and metabolic syndrome. Hepatology 2007; 46(4): 1091-100.

  10. Sasaki A, Nitta H, Otsuka K, Umemura A, Baba S, Obuchi T, et al. Bariatric surgery and non-alcoholic fatty liver disease: current and potential future treatments. Front Endocrinol (Lausanne) 2014; 5: 164.

  11. Petta S, Gastaldelli A, Rebelos E, Bugianesi E, Messa P, Miele L, et al. Pathophysiology of non alcoholic fatty liver disease. Int J Mol Sci 2016; 17(12): E2082.

  12. Polyzos SA, Kountouras J, Zavos C, Tsiaousi E. The role of adiponectin in the pathogenesis and treatment of non-alcoholic fatty liver disease. Diabetes Obes Metab 2010; 12(5): 365-83.

  13. Bajaj JS, Hylemon PB, Younossi Z. The intestinal microbiota and liver disease. Am J Gastroenterol Suppl 2012; 1: 9.

  14. Maximos M, Bril F, Portillo Sanchez P, Lomonaco R, Orsak B, Biernacki D, et al. The role of liver fat and insulin resistance as determinants of plasma aminotransferase elevation in nonalcoholic fatty liver disease. Hepatology 2015; 61(1): 153-60.

  15. Reeder SB, Cruite I, Hamilton G, Sirlin CB. Quantitative assessment of liver fat with magnetic resonance imaging and spectroscopy. J Magn Reson Imaging 2011; 34(4): spcone.

  16. Fedchuk L, Nascimbeni F, Pais R, Charlotte F, Housset C, Ratziu V, et al. Performance and limitations of steatosis biomarkers in patients with nonalcoholic fatty liver disease. Aliment Pharmacol Ther 2014; 40(10): 1209-22.

  17. Arab JP, Hernández-Rocha C, Morales C, Vargas JI, Solís N, Pizarro M, et al. Serum cytokeratin-18 fragment levels as noninvasive marker of nonalcoholic steatohepatitis in the chilean population. Gastroenterol Hepatol 2017; 40(6): 388-94.

  18. European Association for Study of Liver, Asociacion Latinoamericana para el Estudio del Hogado. EASL-ALEH Clinical Practice Guidelines: Non-invasive tests for evaluation of liver disease severity and prognosis. J Hepatol 2015; 63(1): 237-64.

  19. Petta S, Vanni E, Bugianesi E, Di Marco V, Cammà C, Cabibi D, et al. The combination of liver stiffness measurement and NAFLD fibrosis score improves the noninvasive diagnostic accuracy for severe liver fibrosis in patients with nonalcoholic fatty liver disease. Liver Int. 2015; 35(5): 1566-73.

  20. Papamiltiadous ES, Roberts SK, Nicoll AJ, Ryan MC, Itsiopoulos C, Salim A, et al. A randomised controlled trial of a mediterranean dietary intervention for adults with non alcoholic fatty liver disease (MEDINA): study protocol. BMC Gastroenterol 2016; 16: 14.

  21. Vilar-Gomez E, Martinez-Perez Y, Calzadilla-Bertot L, Torres-Gonzalez A, Gra-Oramas B, Gonzalez-Fabian L, et al. Weight loss through lifestyle modification significantly reduces features of nonalcoholic steatohepatitis. Gastroenterology 2015; 149(2): 367-78.e5.

  22. Eckard C, Cole R, Lockwood J, Torres DM, Williams CD, Shaw JC, et al. Prospective histopathologic evaluation of lifestyle modification in nonalcoholic fatty liver disease: a randomized trial. Therap Adv Gastroenterol 2013; 6(4): 249-59.

  23. Tendler D, Lin S, Yancy WS Jr, Mavropoulos J, Sylvestre P, Rockey DC, et al. The effect of a low-carbohydrate, ketogenic diet on nonalcoholic fatty liver disease: a pilot study. Dig Dis Sci 2007; 52(2): 589-93.

  24. Ryan MC, Itsiopoulos C, Thodis T, Ward G, Trost N, Hofferberth S, et al. The Mediterranean diet improves hepatic steatosis and insulin sensitivity in individuals with non-alcoholic fatty liver disease. J Hepatol 2013; 59(1): 138-43.

  25. Eslamparast T, Tandon P, Raman M. Dietary composition independent of weight loss in the management of non-alcoholic fatty liver disease. Nutrients 2017; 9(8). Pii: E800.

  26. Promrat K, Kleiner DE, Niemeier HM, Jackvony E, Kearns M, Wands JR, et al. Randomized controlled trial testing the effects of weight loss on nonalcoholic steatohepatitis. Hepatology 2010; 51(1): 121-9.

  27. Bae JC, Suh S, Park SE, Rhee EJ, Park CY, Oh KW, et al. Regular exercise is associated with a reduction in the risk of NAFLD and decreased liver enzymes in individuals with NAFLD independent of obesity in korean adults. PLoS One. 2012; 7(10): e46819.

  28. Zhang HJ, He J, Pan LL, Ma ZM, Han CK, Chen CS, et al. Effects of moderate and vigorous exercise on nonalcoholic fatty liver disease: a randomized clinical trial. JAMA Intern Med. 2016; 176(8): 1074-82.

  29. Sanyal AJ, Chalasani N, Kowdley KV, McCullough A, Diehl AM, Bass NM, et al. Pioglitazone, vitamin E, or placebo for nonalcoholic steatohepatitis. N Engl J Med 2010; 362(18): 1675-85.

  30. Neuschwander-Tetri BA, Loomba R, Sanyal AJ, Lavine JE, Van Natta ML, Abdelmalek MF, et al. Farnesoid X nuclear receptor ligand obeticholic acid for non-cirrhotic, non-alcoholic steatohepatitis (FLINT): a multicentre, randomised, placebo-controlled trial. Lancet 2015; 385(9972): 956-65.

  31. Armstrong MJ, Gaunt P, Aithal GP, Barton D, Hull D, Parker R, et al. Liraglutide safety and efficacy in patients with non-alcoholic steatohepatitis (LEAN): a multicentre, double-blind, randomised, placebo-controlled phase 2 study. Lancet Lond Engl 2016; 387(10019): 679-90.

  32. Federico A, Zulli C, de Sio I, Del Prete A, Dallio M, Masarone M, et al. Focus on emerging drugs for the treatment of patients with non-alcoholic fatty liver disease. World J Gastroenterol 2014; 20(45): 16841-57.

  33. Imajo K, Yoneda M, Ogawa Y, Wada K, Nakajima A. Microbiota and nonalcoholic steatohepatitis. Semin Immunopathol 2014; 36(1): 115-32.

  34. Loguercio C, Federico A, Tuccillo C, Terracciano F, D’Auria MV, De Simone C, et al. Beneficial effects of a probiotic VSL#3 on parameters of liver dysfunction in chronic liver diseases. J Clin Gastroenterol 2005; 39(6): 540-3.

  35. Shavakhi A, Minakari M, Firouzian H, Assali R, Hekmatdoost A, Ferns G. Effect of a probiotic and metformin on liver aminotransferases in non-alcoholic steatohepatitis: a double blind randomized. Int J Prev Med 2013; 4(5): 531-7.

  36. Li Y, Liu L, Wang B, Chen D. Metformin in non-alcoholic fatty liver disease: A systematic review and meta-analysis. Biomed Rep 2013; 1(1): 57-64.

  37. Athyros VG, Tziomalos K, Gossios TD, Griva T, Anagnostis P, Kargiotis K, et al. Safety and efficacy of long-term statin treatment for cardiovascular events in patients with coronary heart disease and abnormal liver tests in the Greek Atorvastatin and Coronary Heart Disease Evaluation (GREACE) Study: a post-hoc analysis. Lancet Lond Engl 2010; 376(9756): 1916-22.

  38. Eshraghian A. Current and emerging pharmacological therapy for non-alcoholic fatty liver disease. World J Gastroenterol 2017; 23(42): 7495-504.

  39. Gawrieh S, Chalasani N. Emerging treatments for nonalcoholic fatty liver disease and nonalcoholic steatohepatitis. Clin Liver Dis 2018; 22(1): 189-99.

  40. Xiang M, Wang PX, Wang AB, Zhang XJ, Zhang Y, Zhang P, et al. Targeting hepatic TRAF1-ASK1 signaling to improve inflammation, insulin resistance, and hepatic steatosis. J Hepatol 2016; 64(6): 1365-77.

  41. Safadi R, Konikoff FM, Mahamid M, Zelber-Sagi S, Halpern M, Gilat T, et al. The fatty acid-bile acid conjugate Aramchol reduces liver fat content in patients with nonalcoholic fatty liver disease. Clin Gastroenterol Hepatol. 2014; 12(12): 2085-91.

  42. Díaz Coppe-Gutiérrez A, Velázquez-Fernández D, Herrera-Hernández MF, Pantoja-Millán JP, Sierra-Salazar M. El papel de la cirugía bariátrica en el manejo de la enfermedad por hígado graso no alcohólico. Rev Hosp Jua Mex 2017; 84(2): 83-92.

  43. Angulo P, Kleiner DE, Dam-Larsen S, Adams LA, Bjornsson ES, Charatcharoenwitthaya P, et al. Liver fibrosis, but no other histologic features, is associated with long-term outcomes of patients with nonalcoholic fatty liver disease. Gastroenterology 2015; 149(2): 389-97.

  44. Adams LA, Lymp JF, St Sauver J, Sanderson SO, Lindor KD, Feldstein A, et al. The natural history of nonalcoholic fatty liver disease: a population-based cohort study. Gastroenterology 2005; 129(1): 113-21.




2020     |     www.medigraphic.com