Skip to main content

Neues zur nichtalkoholischen Steatohepatitis

New aspects of nonalcoholic steatohepatitis

Der Internist volume 60, pages 128–132 (2019)Cite this article

Zusammenfassung

In den vergangenen zehn Jahren ist die nichtalkoholische Fettlebererkrankung (NAFLD) vermehrt in den Fokus der klinischen Forschung gerückt. Der Begriff NAFLD beinhaltet die einfache nichtalkoholische Steatose oder Fettleber (NAFL) und die nichtalkoholische Steatohepatitis (NASH). Da die Inzidenz der NAFLD stark angestiegen ist, geht man davon aus, dass in den nächsten Jahren vor allem die NASH in vielen industrialisierten Ländern die Hauptursache für die Lebertransplantation sein wird. Weiterhin beobachtet man zunehmend, dass ein zirrhotischer Umbau der Leber direkt und ohne das Durchlaufen des Stadiums der NASH aus der NAFL entstehen kann. Schließlich erhärten sich die Hinweise, dass einerseits sowohl die NAFL als auch die NASH mit einem stark erhöhten Risiko für das Auftreten von Typ-2-Diabetes und kardiovaskulären Erkrankungen einhergeht und andererseits die NAFL und NASH Komplikationen des Diabetes darstellen. Im vorliegenden Beitrag werden aktuelle Erkenntnisse zur Prävalenz, Diagnose, Risikovorhersage und Therapie der NAFLD dargelegt und diskutiert.

Abstract

During the past 10 years nonalcoholic fatty liver disease (NAFLD) has moved more and more into the focus of attention of clinical research. The term NAFLD comprises the simple nonalcoholic steatosis or fatty liver (NAFL) and nonalcoholic steatohepatitis (NASH). As the incidence of NAFLD has dramatically increased, it is expected that during the coming years NASH in particular will become the main reason for liver transplantation in industrialized countries. In addition, it has become evident that scirrhotic liver fibrosis can develop directly from NAFL without going through the stage of NASH. Finally, there is accumulating evidence that both NAFL and NASH are strongly associated with an increased risk of type 2 diabetes and cardiovascular diseases and on the other hand that NAFL and NASH are complications of diabetes. This article addresses the current knowledge about the prevalence, diagnosis, risk prediction and treatment of NAFLD.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Abb. 1
Abb. 2

Literatur

  1. Younossi ZM, Koenig AB, Abdelatif D et al (2016) Global epidemiology of nonalcoholic fatty liver disease-meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology 64:73–84

    Article  Google Scholar 

  2. Anderson EL, Howe LD, Jones HE et al (2015) The prevalence of non-alcoholic fatty liver disease in children and adolescents: a systematic review and meta-analysis. PLoS ONE 10:e140908

    Article  Google Scholar 

  3. Williams CD, Stengel J, Asike MI et al (2011) Prevalence of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis among a largely middle-aged population utilizing ultrasound and liver biopsy: a prospective study. Baillieres Clin Gastroenterol 140:124–131

    Google Scholar 

  4. Diehl AM, Day C (2017) Cause, pathogenesis, and treatment of nonalcoholic Steatohepatitis. N Engl J Med 377:2063–2072

    CAS  Article  Google Scholar 

  5. Singh S, Allen AM, Wang Z et al (2015) Fibrosis progression in nonalcoholic fatty liver vs nonalcoholic steatohepatitis: a systematic review and meta-analysis of paired-biopsy studies. Clin Gastroenterol Hepatol 13:643–654

    Article  Google Scholar 

  6. McPherson S, Hardy T, Henderson E, Burt AD, Day CP, Anstee QM (2015) Evidence of NAFLD progression from steatosis to fibrosing-steatohepatitis using paired biopsies: implications for prognosis and clinical management. J Hepatol 62:1148–1155

    Article  Google Scholar 

  7. Stefan N, Fritsche A, Schick F, Häring HU (2016) Phenotypes of prediabetes and stratification of cardiometabolic risk. Lancet Diabetes Endocrinol 4:789–798

    Article  Google Scholar 

  8. Stefan N, Schick F, Häring HU (2017) Causes, characteristics, and consequences of metabolically unhealthy normal weight in humans. Cell Metab 26:292–300

    CAS  Article  Google Scholar 

  9. 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) (2016) EASL-EASD-EASO clinical practice guidelines for the management of non-alcoholic fatty liver disease. Diabetologia 59:1121–1140

    Article  Google Scholar 

  10. Glen J, Floros L, Day C, Pryke R (2016) Guideline Development Group. Non-alcoholic fatty liver disease (NAFLD): summary of NICE guidance. BMJ 354:i4428

    Article  Google Scholar 

  11. Chalasani N, Younossi Z, Lavine JE et al (2018) The diagnosis and management of nonalcoholic fatty liver disease: practice guidance from the American Association for the Study of Liver Diseases. Hepatology 67:328–357

    Article  Google Scholar 

  12. Roeb E, Steffen HM, Bantel H et al (2015) S2k Guideline non-alcoholic fatty liver disease. Z Gastroenterol 53:668–723

    CAS  Article  Google Scholar 

  13. Paul S, Davis AM (2018) Diagnosis and management of nonalcoholic liver disease. JAMA. https://doi.org/10.1001/jama.2018.17365 (Epub ahead of print)

    Article  PubMed  Google Scholar 

  14. Stefan N, Häring HU, Cusi K (2018) Non-alcoholic fatty liver disease: causes, diagnosis, cardiometabolic consequences, and treatment strategies. Lancet Diabetes Endocrinol S2213-8587(18):30154–30152. https://doi.org/10.1016/S2213-8587 (Epub ahead of print)

    Article  Google Scholar 

  15. Stefan N, Roden M (2018) Diabetes und Fettleber. Diabetol Stoffwechsel 13(Supplement 2):205–209

    Google Scholar 

  16. Dulai PS, Singh S, Patel J et al (2017) Increased risk of mortality by fibrosis stage in nonalcoholic fatty liver disease: systematic review and meta-analysis. Hepatology 65:1557–1565

    CAS  Article  Google Scholar 

  17. Cusi K (2016) Treatment of patients with type 2 diabetes and non-alcoholic fatty liver disease: current approaches and future directions. Diabetologia 59:1112–1120

    CAS  Article  Google Scholar 

  18. Ratziu V (2018) A critical review of endpoints for non-cirrhotic NASH therapeutic trials. J Hepatol 68:353–361

    Article  Google Scholar 

  19. Tilg H, Moschen AR, Roden M (2017) NAFLD and diabetes mellitus. Nat Rev Gastroenterol Hepatol 14:32–42

    CAS  Article  Google Scholar 

Download references

Author information

Affiliations

  1. Abteilung für Innere Medizin IV, Bereiche Endokrinologie, Diabetologie, Angiologie, Nephrologie und Klinische Chemie, Universitätsklinikum Tübingen, Otfried-Müller-Str. 10, 72076, Tübingen, Deutschland

    N. Stefan

  2. Abteilung für Pathophysiologie des Prädiabetes, Institut für Diabetesforschung und Metabolische Erkrankungen (IDM), Helmholtz Zentrum München, Universität Tübingen, Tübingen, Deutschland

    N. Stefan

  3. Harvard Medical School, Boston, MA, USA

    N. Stefan

Authors
  1. N. Stefan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to N. Stefan.

Ethics declarations

Interessenkonflikt

N. Stefan gibt an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden vom Autor keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

Additional information

Redaktion

H. Lehnert, Lübeck

C.C. Sieber, Nürnberg

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Stefan, N. Neues zur nichtalkoholischen Steatohepatitis. Internist 60, 128–132 (2019). https://doi.org/10.1007/s00108-018-0550-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00108-018-0550-y

Schlüsselwörter

  • Nichtalkoholische Fettlebererkrankung
  • Diabetes mellitus Typ 2
  • Kardiovaskuläre Erkrankungen
  • Leberzirrhose
  • Entzündung

Keywords

  • Nonalcoholic fatty liver disease
  • Diabetes mellitus, type 2
  • Cardiovascular diseases
  • Liver cirrhosis
  • Inflammation