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Obesity and NAFLD: Same Problem?

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Non-Alcoholic Fatty Liver Disease

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Abstract

Obesity—namely visceral obesity—is definitely the core of the metabolic syndrome, having insulin resistance as the central metabolic defect. Body fat accumulation and insulin resistance mutually feed each other, and progressive lipotoxicity, i.e., accumulation of fat in adipose tissue stores, finally involves several organs, including the liver. The primary defect may be genetic in origin, or promoted by epigenetic modifications, or, more commonly, by unhealthy lifestyles (both unhealthy diet and poor physical activity), progressively leading to obesity. Nonalcoholic fatty liver disease is one of such conditions, possibly further impairing insulin sensitivity and favoring other comorbidities. The presence of “lean NAFLD” does not confute this theory: it must be regarded as a condition with a much more genetic imprinting in subjects who long maintain an adequate lifestyle. However, in most cases, favored by the accumulation of body fat and reduced physical activity that are common along the years, also these subjects are prone to develop visceral obesity. They might be considered “metabolically unhealthy normal weight” subjects, as opposed to the “metabolically healthy obese” individuals. In most cases, a variable drive of genes and lifestyle is probably the basis for differences that tend to produce obesity and metabolic diseases, including NAFLD, in the course of life.

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References

  1. Unger RH. Lipotoxic diseases. Annu Rev Med. 2002;53:319–36.

    CAS  PubMed  Google Scholar 

  2. Marra F, Bertolani C. Adipokines in liver diseases. Hepatology. 2009;50:957–69.

    CAS  PubMed  Google Scholar 

  3. Alberti KG, Zimmet P, Shaw J. The metabolic syndrome—a new worldwide definition. Lancet. 2005;366:1059–62.

    PubMed  Google Scholar 

  4. Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, et al. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation. 2009;120:1640–5.

    CAS  PubMed  Google Scholar 

  5. Maison P, Byrne CD, Hales CN, Day NE, Wareham NJ. Do different dimensions of the metabolic syndrome change together over time? Evidence supporting obesity as the central feature. Diabetes Care. 2001;24:1758–63.

    CAS  PubMed  Google Scholar 

  6. Younossi Z, Anstee QM, Marietti M, Hardy T, Henry L, Eslam M, et al. Global burden of NAFLD and NASH: trends, predictions, risk factors and prevention. Nat Rev Gastroenterol Hepatol. 2018;15:11–20.

    PubMed  Google Scholar 

  7. Marchesini G, Bugianesi E, Forlani G, Cerrelli F, Lenzi M, Manini R, et al. Nonalcoholic fatty liver, steatohepatitis, and the metabolic syndrome. Hepatology. 2003;37:917–23.

    PubMed  Google Scholar 

  8. Lonardo A, Ballestri S, Marchesini G, Angulo P, Loria P. Nonalcoholic fatty liver disease: a precursor of the metabolic syndrome. Dig Liver Dis. 2015;47:181–90.

    PubMed  Google Scholar 

  9. Younossi ZM, Stepanova M, Negro F, Hallaji S, Younossi Y, Lam B, et al. Nonalcoholic fatty liver disease in lean individuals in the United States. Medicine (Baltimore). 2012;91:319–27.

    Google Scholar 

  10. Marchesini G, Brizi M, Morselli-Labate AM, Bianchi G, Bugianesi E, McCullough AJ, et al. Association of nonalcoholic fatty liver disease with insulin resistance. Am J Med. 1999;107:450–5.

    CAS  PubMed  Google Scholar 

  11. Rosso C, Mezzabotta L, Gaggini M, Salomone F, Gambino R, Marengo A, et al. Peripheral insulin resistance predicts liver damage in nondiabetic subjects with nonalcoholic fatty liver disease. Hepatology. 2016;63:107–16.

    CAS  PubMed  Google Scholar 

  12. Alizadeh S, Ahmadi M, Ghorbani Nejad B, Djazayeri A, Shab-Bidar S. Metabolic syndrome and its components are associated with increased chronic kidney disease risk: evidence from a meta-analysis on 11,109,003 participants from 66 studies. Int J Clin Pract. 2018;72:e13201.

    Google Scholar 

  13. Bellentani S, Tiribelli C. Is it time to change NAFLD and NASH nomenclature? Lancet Gastroenterol Hepatol. 2017;2:547–8.

    PubMed  Google Scholar 

  14. Dufour JF. Time to abandon NASH? Hepatology. 2016;63:9–10.

    PubMed  Google Scholar 

  15. Eslam M, Sanyal AJ, George J. Toward more accurate nomenclature for fatty liver diseases. Gastroenterology. 2019;157:590–3.

    PubMed  Google Scholar 

  16. Eslam M, Sanyal AJ, George J, International Consensus Panel. MAFLD: a consensus-driven proposed nomenclature for Metabolic Associated Fatty Liver Disease. Gastroenterology. 2020;158:1999–2014. e1991.

    CAS  PubMed  Google Scholar 

  17. Singh S, Allen AM, Wang Z, Prokop LJ, Murad MH, Loomba R. Fibrosis progression in nonalcoholic fatty liver vs nonalcoholic steatohepatitis: a systematic review and meta-analysis of paired-biopsy studies. Clin Gastroenterol Hepatol. 2015;13:643–54, e641–649; quiz e639–640.

    PubMed  Google Scholar 

  18. Marra F, Gastaldelli A, Svegliati Baroni G, Tell G, Tiribelli C. Molecular basis and mechanisms of progression of non-alcoholic steatohepatitis. Trends Mol Med. 2008;14:72–81.

    CAS  PubMed  Google Scholar 

  19. Mazzotti A, Caletti MT, Sasdelli AS, Brodosi L, Marchesini G. Pathophysiology of nonalcoholic fatty liver disease: lifestyle-gut-gene interaction. Dig Dis. 2016;34(Suppl 1):3–10.

    PubMed  Google Scholar 

  20. Cortez-Pinto H, Jesus L, Barros H, Lopes C, Moura MC, Camilo ME. How different is the dietary pattern in non-alcoholic steatohepatitis patients? Clin Nutr. 2006;25:816–23.

    CAS  PubMed  Google Scholar 

  21. Solga S, Alkhuraishe AR, Clark JM, Torbenson M, Greenwald A, Diehl AM, et al. Dietary composition and nonalcoholic fatty liver disease. Dig Dis Sci. 2004;49:1578–83.

    PubMed  Google Scholar 

  22. Green CJ, Hodson L. The influence of dietary fat on liver fat accumulation. Nutrients. 2014;6:5018–33.

    PubMed  PubMed Central  Google Scholar 

  23. Utzschneider KM, Bayer-Carter JL, Arbuckle MD, Tidwell JM, Richards TL, Craft S. Beneficial effect of a weight-stable, low-fat/low-saturated fat/low-glycaemic index diet to reduce liver fat in older subjects. Br J Nutr. 2013;109:1096–104.

    CAS  PubMed  Google Scholar 

  24. Rosqvist F, Iggman D, Kullberg J, Cedernaes J, Johansson HE, Larsson A, et al. Overfeeding polyunsaturated and saturated fat causes distinct effects on liver and visceral fat accumulation in humans. Diabetes. 2014;63:2356–68.

    PubMed  Google Scholar 

  25. Abdelmalek MF, Suzuki A, Guy C, Unalp-Arida A, Colvin R, Johnson RJ, et al. Increased fructose consumption is associated with fibrosis severity in patients with nonalcoholic fatty liver disease. Hepatology. 2010;51:1961–71.

    CAS  PubMed  Google Scholar 

  26. Jensen T, Abdelmalek MF, Sullivan S, Nadeau KJ, Green M, Roncal C, et al. Fructose and sugar: a major mediator of non-alcoholic fatty liver disease. J Hepatol. 2018;68:1063–75.

    CAS  PubMed  PubMed Central  Google Scholar 

  27. Zelber-Sagi S, Nitzan-Kaluski D, Goldsmith R, Webb M, Blendis L, Halpern Z, et al. Long term nutritional intake and the risk for non-alcoholic fatty liver disease (NAFLD): a population based study. J Hepatol. 2007;47:711–7.

    CAS  PubMed  Google Scholar 

  28. Maersk M, Belza A, Stodkilde-Jorgensen H, Ringgaard S, Chabanova E, Thomsen H, et al. Sucrose-sweetened beverages increase fat storage in the liver, muscle, and visceral fat depot: a 6-mo randomized intervention study. Am J Clin Nutr. 2012;95:283–9.

    CAS  PubMed  Google Scholar 

  29. Zelber-Sagi S, Salomone F, Mlynarsky L. The Mediterranean dietary pattern as the diet of choice for non-alcoholic fatty liver disease: evidence and plausible mechanisms. Liver Int. 2017;37:936–49.

    CAS  PubMed  Google Scholar 

  30. Hannukainen JC, Nuutila P, Borra R, Kaprio J, Kujala UM, Janatuinen T, et al. Increased physical activity decreases hepatic free fatty acid uptake: a study in human monozygotic twins. J Physiol. 2007;578:347–58.

    Article  CAS  PubMed  Google Scholar 

  31. Ryu S, Chang Y, Jung HS, Yun KE, Kwon MJ, Choi Y, et al. Relationship of sitting time and physical activity with non-alcoholic fatty liver disease. J Hepatol. 2015;63:1229–37.

    Article  PubMed  Google Scholar 

  32. Healy GN, Dunstan DW, Salmon J, Cerin E, Shaw JE, Zimmet PZ, et al. Breaks in sedentary time: beneficial associations with metabolic risk. Diabetes Care. 2008;31:661–6.

    Article  PubMed  Google Scholar 

  33. Valenti LVC, Baselli GA. Genetics of nonalcoholic fatty liver disease: a 2018 update. Curr Pharm Des. 2018;24:4566–73.

    Article  CAS  PubMed  Google Scholar 

  34. Johansson LE, Hoffstedt J, Parikh H, Carlsson E, Wabitsch M, Bondeson AG, et al. Variation in the adiponutrin gene influences its expression and associates with obesity. Diabetes. 2006;55:826–33.

    Article  CAS  PubMed  Google Scholar 

  35. Romeo S, Kozlitina J, Xing C, Pertsemlidis A, Cox D, Pennacchio LA, et al. Genetic variation in PNPLA3 confers susceptibility to nonalcoholic fatty liver disease. Nat Genet. 2008;40:1461–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Romeo S, Sentinelli F, Dash S, Yeo GS, Savage DB, Leonetti F, et al. Morbid obesity exposes the association between PNPLA3 I148M (rs738409) and indices of hepatic injury in individuals of European descent. Int J Obes. 2010;34:190–4.

    Article  CAS  Google Scholar 

  37. Sookoian S, Pirola CJ. Meta-analysis of the influence of I148M variant of patatin-like phospholipase domain containing 3 gene (PNPLA3) on the susceptibility and histological severity of nonalcoholic fatty liver disease. Hepatology. 2011;53:1883–94.

    Article  CAS  PubMed  Google Scholar 

  38. Valenti L, Al-Serri A, Daly AK, Galmozzi E, Rametta R, Dongiovanni P, et al. Homozygosity for the patatin-like phospholipase-3/adiponutrin I148M polymorphism influences liver fibrosis in patients with nonalcoholic fatty liver disease. Hepatology. 2010;51:1209–17.

    Article  CAS  PubMed  Google Scholar 

  39. Liu YL, Patman GL, Leathart JB, Piguet AC, Burt AD, Dufour JF, et al. Carriage of the PNPLA3 rs738409 C >G polymorphism confers an increased risk of non-alcoholic fatty liver disease associated hepatocellular carcinoma. J Hepatol. 2014;61:75–81.

    Article  CAS  PubMed  Google Scholar 

  40. Kozlitina J, Smagris E, Stender S, Nordestgaard BG, Zhou HH, Tybjaerg-Hansen A, et al. Exome-wide association study identifies a TM6SF2 variant that confers susceptibility to nonalcoholic fatty liver disease. Nat Genet. 2014;46:352–6.

    CAS  PubMed  PubMed Central  Google Scholar 

  41. Liu YL, Reeves HL, Burt AD, Tiniakos D, McPherson S, Leathart JB, et al. TM6SF2 rs58542926 influences hepatic fibrosis progression in patients with non-alcoholic fatty liver disease. Nat Commun. 2014;5:4309.

    CAS  PubMed  Google Scholar 

  42. Sookoian S, Castano GO, Scian R, Mallardi P, Fernandez Gianotti T, Burgueno AL, et al. Genetic variation in transmembrane 6 superfamily member 2 and the risk of nonalcoholic fatty liver disease and histological disease severity. Hepatology. 2015;61:515–25.

    CAS  PubMed  Google Scholar 

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

    Google Scholar 

  44. Abul-Husn NS, Cheng X, Li AH, Xin Y, Schurmann C, Stevis P, et al. A protein-truncating HSD17B13 variant and protection from chronic liver disease. N Engl J Med. 2018;378:1096–106.

    CAS  PubMed  PubMed Central  Google Scholar 

  45. Barker DJ. The fetal and infant origins of adult disease. BMJ. 1990;301:1111.

    CAS  PubMed  PubMed Central  Google Scholar 

  46. Suomela E, Oikonen M, Pitkanen N, Ahola-Olli A, Virtanen J, Parkkola R, et al. Childhood predictors of adult fatty liver. The Cardiovascular Risk in Young Finns Study. J Hepatol. 2016;65:784–90.

    PubMed  Google Scholar 

  47. Nobili V, Marcellini M, Marchesini G, Vanni E, Manco M, Villani A, et al. Intrauterine growth retardation, insulin resistance, and nonalcoholic fatty liver disease in children. Diabetes Care. 2007;30:2638–40.

    PubMed  Google Scholar 

  48. Dudley KJ, Sloboda DM, Connor KL, Beltrand J, Vickers MH. Offspring of mothers fed a high fat diet display hepatic cell cycle inhibition and associated changes in gene expression and DNA methylation. PLoS One. 2011;6:e21662.

    CAS  PubMed  PubMed Central  Google Scholar 

  49. Pimpin L, Cortez-Pinto H, Negro F, Corbould E, Lazarus JV, Webber L, et al. Burden of liver disease in Europe: epidemiology and analysis of risk factors to identify prevention policies. J Hepatol. 2018;69:718.

    PubMed  Google Scholar 

  50. Suzuki A, Angulo P, Lymp J, St Sauver J, Muto A, Okada T, et al. Chronological development of elevated aminotransferases in a nonalcoholic population. Hepatology. 2005;41:64–71.

    CAS  PubMed  Google Scholar 

  51. Sung KC, Wild SH, Byrne CD. Development of new fatty liver, or resolution of existing fatty liver, over five years of follow-up, and risk of incident hypertension. J Hepatol. 2014;60:1040–5.

    PubMed  Google Scholar 

  52. Sung KC, Wild SH, Byrne CD. Resolution of fatty liver and risk of incident diabetes. J Clin Endocrinol Metab. 2013;98:3637–43.

    CAS  PubMed  Google Scholar 

  53. Targher G, Marchesini G, Byrne CD. Risk of type 2 diabetes in patients with non-alcoholic fatty liver disease: causal association or epiphenomenon? Diabetes Metab. 2016;42:142–56.

    CAS  PubMed  Google Scholar 

  54. Estes C, Anstee QM, Arias-Loste MT, Bantel H, Bellentani S, Caballeria J, et al. Modeling NAFLD disease burden in China, France, Germany, Italy, Japan, Spain, United Kingdom, and United States for the period 2016-2030. J Hepatol. 2018;69:896–904.

    PubMed  Google Scholar 

  55. Zelber-Sagi S, Lotan R, Shlomai A, Webb M, Harrari G, Buch A, et al. Predictors for incidence and remission of NAFLD in the general population during a seven-year prospective follow-up. J Hepatol. 2012;56:1145–51.

    PubMed  Google Scholar 

  56. Chang Y, Ryu S, Sung E, Woo HY, Cho SI, Yoo SH, et al. Weight gain within the normal weight range predicts ultrasonographically detected fatty liver in healthy Korean men. Gut. 2009;58:1419–25.

    CAS  PubMed  Google Scholar 

  57. Hagstrom H, Stal P, Hultcrantz R, Hemmingsson T, Andreasson A. Overweight in late adolescence predicts development of severe liver disease later in life: a 39 years follow-up study. J Hepatol. 2016;65:363–8.

    PubMed  Google Scholar 

  58. Berentzen TL, Gamborg M, Holst C, Sorensen TI, Baker JL. Body mass index in childhood and adult risk of primary liver cancer. J Hepatol. 2014;60:325–30.

    PubMed  Google Scholar 

  59. Berzigotti A, Albillos A, Villanueva C, Genesca J, Ardevol A, Augustin S, et al. Effects of an intensive lifestyle intervention program on portal hypertension in patients with cirrhosis and obesity: the SportDiet study. Hepatology. 2017;65:1293–305.

    PubMed  Google Scholar 

  60. Emerging Risk Factors Collaboration, Di Angelantonio E, Kaptoge S, Wormser D, Willeit P, Butterworth AS, et al. Association of cardiometabolic multimorbidity with mortality. JAMA. 2015;314:52–60.

    Google Scholar 

  61. Kivimaki M, Kuosma E, Ferrie JE, Luukkonen R, Nyberg ST, Alfredsson L, et al. Overweight, obesity, and risk of cardiometabolic multimorbidity: pooled analysis of individual-level data for 120 813 adults from 16 cohort studies from the USA and Europe. Lancet Public Health. 2017;2:e277–85.

    PubMed  PubMed Central  Google Scholar 

  62. Hsu CY, McCulloch CE, Iribarren C, Darbinian J, Go AS. Body mass index and risk for end-stage renal disease. Ann Intern Med. 2006;144:21–8.

    PubMed  Google Scholar 

  63. Cao X, Zhou J, Yuan H, Wu L, Chen Z. Chronic kidney disease among overweight and obesity with and without metabolic syndrome in an urban Chinese cohort. BMC Nephrol. 2015;16:85.

    PubMed  PubMed Central  Google Scholar 

  64. Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004;351:1296–305.

    CAS  PubMed  Google Scholar 

  65. Calle EE, Rodriguez C, Walker-Thurmond K, Thun MJ. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. N Engl J Med. 2003;348:1625–38.

    PubMed  Google Scholar 

  66. Renehan AG, Tyson M, Egger M, Heller RF, Zwahlen M. Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies. Lancet. 2008;371:569–78.

    PubMed  Google Scholar 

  67. Sjostrom L, Gummesson A, Sjostrom CD, Narbro K, Peltonen M, Wedel H, et al. Effects of bariatric surgery on cancer incidence in obese patients in Sweden (Swedish Obese Subjects Study): a prospective, controlled intervention trial. Lancet Oncol. 2009;10:653–62.

    PubMed  Google Scholar 

  68. Allen AM, Hicks SB, Mara KC, Larson JJ, Therneau TM. The risk of incident extrahepatic cancers is higher in non-alcoholic fatty liver disease than obesity—A longitudinal cohort study. J Hepatol. 2019;71:1229–36.

    PubMed  PubMed Central  Google Scholar 

  69. Marchesini G, Petroni ML, Cortez-Pinto H. Adipose-tissue-associated cancer risk: is it the fat around the liver, or the fat inside the liver? J Hepatol. 2019;71:1073–5.

    PubMed  Google Scholar 

  70. Ekstedt M, Franzen LE, Mathiesen UL, Thorelius L, Holmqvist M, Bodemar G, et al. Long-term follow-up of patients with NAFLD and elevated liver enzymes. Hepatology. 2006;44:865–73.

    CAS  PubMed  Google Scholar 

  71. Wong VW, Wong GL, Yip GW, Lo AO, Limquiaco J, Chu WC, et al. Coronary artery disease and cardiovascular outcomes in patients with non-alcoholic fatty liver disease. Gut. 2011;60:1721–7.

    CAS  PubMed  Google Scholar 

  72. Bugianesi E, Leone N, Vanni E, Marchesini G, Brunello F, Carucci P, et al. Expanding the natural history of nonalcoholic steatohepatitis: from cryptogenic cirrhosis to hepatocellular carcinoma. Gastroenterology. 2002;123:134–40.

    PubMed  Google Scholar 

  73. Kim GA, Lee HC, Choe J, Kim MJ, Lee MJ, Chang HS, et al. Association between non-alcoholic fatty liver disease and cancer incidence rate. J Hepatol. 2018;68:140–6.

    Google Scholar 

  74. Navarro E, Funtikova AN, Fito M, Schroder H. Can metabolically healthy obesity be explained by diet, genetics, and inflammation? Mol Nutr Food Res. 2015;59:75–93.

    Article  CAS  PubMed  Google Scholar 

  75. Gomez-Ambrosi J, Catalan V, Rodriguez A, Andrada P, Ramirez B, Ibanez P, et al. Increased cardiometabolic risk factors and inflammation in adipose tissue in obese subjects classified as metabolically healthy. Diabetes Care. 2014;37:2813–21.

    Article  CAS  PubMed  Google Scholar 

  76. Vos B, Moreno C, Nagy N, Fery F, Cnop M, Vereerstraeten P, et al. Lean non-alcoholic fatty liver disease (Lean-NAFLD): a major cause of cryptogenic liver disease. Acta Gastroenterol Belg. 2011;74:389–94.

    PubMed  Google Scholar 

  77. Fracanzani AL, Valenti L, Bugianesi E, Vanni E, Grieco A, Miele L, et al. Risk of nonalcoholic steatohepatitis and fibrosis in patients with nonalcoholic fatty liver disease and low visceral adiposity. J Hepatol. 2011;54:1244–9.

    Article  CAS  PubMed  Google Scholar 

  78. Caldwell S, Marchesini G. Cryptogenic vs. NASH-cirrhosis: the rose exists well before its name. J Hepatol. 2018;68:391–2.

    Article  PubMed  Google Scholar 

  79. Thuluvath PJ, Kantsevoy S, Thuluvath AJ, Savva Y. Is cryptogenic cirrhosis different from NASH cirrhosis? J Hepatol. 2018;68:519–25.

    Article  PubMed  Google Scholar 

  80. Sookoian S, Pirola CJ. Systematic review with meta-analysis: the significance of histological disease severity in lean patients with nonalcoholic fatty liver disease. Aliment Pharmacol Ther. 2018;47:16–25.

    CAS  PubMed  Google Scholar 

  81. Dela Cruz AC, Bugianesi E, George J, Day CP, Liaquat H, Charatcharoenwitthaya P, et al. Characteristics and long-term prognosis of lean patients with nonalcoholic fatty liver disease. Gastroenterology. 2014;146:S-909.

    Google Scholar 

  82. Mazzotti A, Caletti MT, Brodosi L, Di Domizio S, Forchielli ML, Petta S, et al. An internet-based approach for lifestyle changes in patients with NAFLD: two-year effects on weight loss and surrogate markers. J Hepatol. 2018;69:1155–63.

    PubMed  Google Scholar 

  83. Centis E, Moscatiello S, Bugianesi E, Bellentani S, Fracanzani AL, Calugi S, et al. Stage of change and motivation to healthier lifestyle in non-alcoholic fatty liver disease. J Hepatol. 2013;58:771–7.

    PubMed  Google Scholar 

  84. Pieniak Z, Zakowska-Biemans S, Kostyra E, Raats M. Sustainable healthy eating behaviour of young adults: towards a novel methodological approach. BMC Public Health. 2016;16:577.

    PubMed  PubMed Central  Google Scholar 

  85. Germani A, Vitiello V, Giusti AM, Pinto A, Donini LM, del Balzo V. Environmental and economic sustainability of the Mediterranean diet. Int J Food Sci Nutr. 2014;65:1008–12.

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Medical and Surgical Sciences, “Alma Mater” University of Bologna, Bologna, Italy

    Lucia Brodosi, Francesca Alessandra Barbanti, Maria Letizia Petroni, Francesca Marchignoli & Giulio Marchesini

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  1. Lucia Brodosi
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  2. Francesca Alessandra Barbanti
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  4. Francesca Marchignoli
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  5. Giulio Marchesini
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Correspondence to Giulio Marchesini .

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  1. Department of Medical Sciences, Division of Gastroentrology and Hepatology, University of Turin, Turin, Italy

    Elisabetta Bugianesi

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Brodosi, L., Barbanti, F.A., Petroni, M.L., Marchignoli, F., Marchesini, G. (2020). Obesity and NAFLD: Same Problem?. In: Bugianesi, E. (eds) Non-Alcoholic Fatty Liver Disease. Springer, Cham. https://doi.org/10.1007/978-3-319-95828-6_1

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