Skip to main content

Adult Non-alcoholic Fatty Liver Disease (NAFLD)

  • 1058 Accesses

Abstract

Non-alcoholic fatty liver disease (NAFLD), a consequence of obesity and metabolic disturbances, is currently the leading cause of chronic liver disease in Western countries. NAFLD, however, varies greatly in disease severity and ranges from the relatively benign condition non-alcoholic fatty liver (NAFL) over the aggressive subtypes non-alcoholic steatohepatitis (NASH) to liver fibrosis and even cirrhosis. Patients with NAFLD are at increased risk of suffering from liver- and cardiovascular related mortality; however, there is still a knowledge gap on the natural history of the disease. The disease is of complex and of multifactorial origin and although NAFLD prevalence is continuously increasing there is a need of better tools regarding screening, diagnosing and treating the condition. Consequently, diagnosing NAFLD, predicting the prognosis, and treating the disease remain an everyday clinical challenge. This book chapter focuses on the burden of NAFLD and in the context of metabolic disease, NAFLD pathophysiology, and managing of the NAFLD patient in clinical practice.

Keywords

  • NAFLD
  • NASH
  • Liver fibrosis
  • Cirrhosis
  • Metabolic syndrome
  • Insulin resistance
  • Obesity
  • NAFLD pathophysiology
  • NAFLD diagnosis
  • NAFLD treatment

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

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD   129.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Bellentani S. The epidemiology of non-alcoholic fatty liver disease. Liver Int. 2017;37:81–4.

    CrossRef  PubMed  Google Scholar 

  2. Younossi ZM, Blissett D, Blissett R, Henry L, Stepanova M, Younossi Y, et al. The economic and clinical burden of nonalcoholic fatty liver disease in the United States and Europe. Hepatology. 2016;64(5):1577–86.

    CrossRef  PubMed  Google Scholar 

  3. Allen AM, Terry TM, Larson JJ, Coward A, Somers VK, Kamath PS. Nonalcoholic fatty liver disease incidence and impact on metabolic burden and death: a 20 year-community study. Hepatology. 2018;67(5):1726–36.

    CrossRef  CAS  PubMed  Google Scholar 

  4. WHO. Obesity and overweight [Internet]. WHO. [cited 2015 Apr 8]. Available from: http://www.who.int/mediacentre/factsheets/fs311/en/

  5. Prentice AM. The emerging epidemic of obesity in developing countries. Int J Epidemiol. 2006;35(1):93–9.

    CrossRef  PubMed  Google Scholar 

  6. Ong JP, Elariny H, Collantes R, Younoszai A, Chandhoke V, Reines HD, et al. Predictors of nonalcoholic steatohepatitis and advanced fibrosis in morbidly obese patients. Obes Surg. 2005;15(3):310–5.

    CrossRef  PubMed  Google Scholar 

  7. Wong RJ, Aguilar M, Cheung R, Perumpail RB, Harrison SA, Younossi ZM, et al. Nonalcoholic steatohepatitis is the second leading etiology of liver disease among adults awaiting liver transplantation in the United States. Gastroenterology. 2015;148(3):547–55.

    CrossRef  PubMed  Google Scholar 

  8. Targher G. Non-alcoholic fatty liver disease and risk of incident cardiovascular disease: a meta-analysis. J Hepatol. 2016;65(3):589–600.

    CrossRef  PubMed  Google Scholar 

  9. Fabbrini E, Sullivan S, Klein S. Obesity and nonalcoholic fatty liver disease: biochemical, metabolic and clinical implications. Hepatology. 2010;51(2):679–89.

    CrossRef  CAS  PubMed  Google Scholar 

  10. 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. Diabetologia. 2016;59(6):1121–40.

    CrossRef  Google Scholar 

  11. 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 Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association. Hepatology. 2012;55(6):2005–23.

    CrossRef  PubMed  Google Scholar 

  12. Lonardo A. Epidemiological modifiers of non-alcoholic fatty liver disease: focus on high-risk groups. Dig Liver Dis. 2015;47(12):997–1006.

    CrossRef  PubMed  Google Scholar 

  13. Ruhl CE, Everhart JE. Determinants of the association of overweight with elevated serum alanine aminotransferase activity in the United States. Gastroenterology. 2003;124(1):71–9.

    CrossRef  CAS  PubMed  Google Scholar 

  14. Vernon G, Baranova A, Younossi ZM. Systematic review: the epidemiology and natural history of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in adults: systematic review: epidemiology of NAFLD and NASH. Aliment Pharmacol Ther. 2011;34(3):274–85.

    CrossRef  CAS  PubMed  Google Scholar 

  15. Marcos A, Fisher RA, Ham JM, Olzinski AT, Shiffman ML, Sanyal AJ, et al. Selection and outcome of living donors for adult to adult right lobe transplantation. Transplantation. 2000;69(11):2410–5.

    CrossRef  CAS  PubMed  Google Scholar 

  16. Hilden M, Christoffersen P, Juhl E, Dalgaard JB. Liver histology in a “normal” population--examinations of 503 consecutive fatal traffic casualties. Scand J Gastroenterol. 1977;12(5):593–7.

    CrossRef  CAS  PubMed  Google Scholar 

  17. Lee RG. Nonalcoholic steatohepatitis: a study of 49 patients. Hum Pathol. 1989;20(6):594–8.

    CrossRef  CAS  PubMed  Google Scholar 

  18. Dixon JB, Bhathal PS, O’Brien PE. Nonalcoholic fatty liver disease: predictors of nonalcoholic steatohepatitis and liver fibrosis in the severely obese. Gastroenterology. 2001;121(1):91–100.

    CrossRef  CAS  PubMed  Google Scholar 

  19. Abrams GA, Kunde SS, Lazenby AJ, Clements RH. Portal fibrosis and hepatic steatosis in morbidly obese subjects: a spectrum of nonalcoholic fatty liver disease. Hepatology. 2004;40(2):475–83.

    CrossRef  PubMed  Google Scholar 

  20. Shalhub S. The importance of routine liver biopsy in diagnosing nonalcoholic steatohepatitis in bariatric patients. Obes Surg. 2004;14(1):54–9.

    CrossRef  PubMed  Google Scholar 

  21. Moretto M, Kupski C, Mottin CC, Repetto G, Garcia Toneto M, Rizzolli J, et al. Hepatic steatosis in patients undergoing bariatric surgery and its relationship to body mass index and co-morbidities. Obes Surg. 2003;13(4):622–4.

    CrossRef  PubMed  Google Scholar 

  22. Ong JP, Elariny H, Collantes R, Younoszai A, Chandhoke V, Reines HD, et al. Predictors of nonalcoholic steatohepatitis and advanced fibrosis in morbidly obese patients. Obes Surg. 2005;15(3):310–5.

    CrossRef  PubMed  Google Scholar 

  23. Grundy SM, Adams-Huet B, Vega GL. Variable contributions of fat content and distribution to metabolic syndrome risk factors. Metab Syndr Relat Disord. 2008;6(4):281–8.

    CrossRef  CAS  PubMed  PubMed Central  Google Scholar 

  24. Goossens GH. The metabolic phenotype in obesity: fat mass, body fat distribution, and adipose tissue function. Obes Facts. 2017;10(3):207–15.

    CrossRef  CAS  PubMed  PubMed Central  Google Scholar 

  25. 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(5):1145–51.

    CrossRef  PubMed  Google Scholar 

  26. Angulo P, Keach JC, Batts KP, Lindor KD. Independent predictors of liver fibrosis in patients with nonalcoholic steatohepatitis. Hepatology. 1999;30(6):1356–62.

    CrossRef  CAS  PubMed  Google Scholar 

  27. 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 Apr 24;348(17):1625–38.

    CrossRef  PubMed  Google Scholar 

  28. Perona JS, Schmidt-Riovalle J, Rueda-Medina B, Correa-Rodríguez M, González-Jiménez E. Waist circumference shows the highest predictive value for metabolic syndrome, and waist-to-hip ratio for its components, in Spanish adolescents. Nutr Res. 2017;45:38–45.

    CrossRef  CAS  PubMed  Google Scholar 

  29. Ohlson L-O, Larsson B, Svärdsudd K, Welin L, Eriksson H, Wilhelmsen L, et al. The influence of body fat distribution on the incidence of diabetes mellitus: 13.5 years of follow-up of the participants in the study of men born in 1913. Diabetes. 1985;34(10):1055–8.

    CrossRef  CAS  PubMed  Google Scholar 

  30. Loomba R, Abraham M, Tech B, Unalp A, Wilson L, Lavine J, et al. Association between diabetes, family history of diabetes and risk of nonalcoholic steatohepatitis and fibrosis. Hepatology. 2012;56(3):943–51.

    CrossRef  PubMed  Google Scholar 

  31. Lonardo A, Sookoian S, Chonchol M, Loria P, Targher G. Cardiovascular and systemic risk in nonalcoholic fatty liver disease – atherosclerosis as a major player in the natural course of NAFLD. Curr Pharm Des. 2013;19(29):5177–92.

    CrossRef  CAS  PubMed  Google Scholar 

  32. Alberti KGMM, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, et al. Harmonizing the metabolic syndrome. Circulation. 2009;120(16):1640–5.

    CrossRef  CAS  PubMed  Google Scholar 

  33. Aron-Wisnewsky J. Chronic intermittent hypoxia is a major trigger for non-alcoholic fatty liver disease in morbid obese. J Hepatol. 2012;56(1):225–33.

    CrossRef  CAS  PubMed  Google Scholar 

  34. Hossain N, Stepanova M, Afendy A, Nader F, Younossi Y, Rafiq N, et al. Non-alcoholic steatohepatitis (NASH) in patients with polycystic ovarian syndrome (PCOS). Scand J Gastroenterol. 2011;46(4):479–84.

    CrossRef  PubMed  Google Scholar 

  35. 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(6):319–27.

    CrossRef  Google Scholar 

  36. Sookoian S, Pirola CJ. Systematic review with meta-analysis: risk factors for non-alcoholic fatty liver disease suggest a shared altered metabolic and cardiovascular profile between lean and obese patients. Aliment Pharmacol Ther. 2017;46(2):85–95.

    CrossRef  CAS  PubMed  Google Scholar 

  37. Kim HJ, Kim HJ, Lee KE, Kim DJ, Kim SK, Ahn CW, et al. Metabolic significance of nonalcoholic fatty liver disease in nonobese, nondiabetic adults. Arch Intern Med. 2004;164(19):2169–75.

    CrossRef  PubMed  Google Scholar 

  38. Lear SA, Humphries KH, Kohli S, Chockalingam A, Frohlich JJ, Birmingham CL. Visceral adipose tissue accumulation differs according to ethnic background: Results of the Multicultural Community Health Assessment Trial (M-CHAT). Am J Clin Nutr. 2007;86(2):353–9.

    CrossRef  CAS  PubMed  Google Scholar 

  39. Rich NE, Oji S, Mufti AR, Browning JD, Parikh ND, Odewole M, et al. Racial and ethnic disparities in non-alcoholic fatty liver disease prevalence, severity, and outcomes in the United States: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2018;16(2):198–210.e2.

    CrossRef  PubMed  Google Scholar 

  40. Kalia HS. The prevalence and pathobiology of nonalcoholic fatty liver disease in patients of different races or ethnicities. Clin Liver Dis. 2016;20(2):215–24.

    CrossRef  PubMed  Google Scholar 

  41. 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(6):1883–94.

    CrossRef  CAS  PubMed  Google Scholar 

  42. 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(12):1461–5.

    CrossRef  CAS  PubMed  PubMed Central  Google Scholar 

  43. Wang Z, Xu M, Hu Z, Hultström M, Lai E. Sex-specific prevalence of fatty liver disease and associated metabolic factors in Wuhan, south central China. Eur J Gastroenterol Hepatol. 2014;26(9):1015–21.

    CrossRef  CAS  PubMed  Google Scholar 

  44. Caballería L, Pera G, Auladell MA, Torán P, Muñoz L, Miranda D, et al. Prevalence and factors associated with the presence of nonalcoholic fatty liver disease in an adult population in Spain. Eur J Gastroenterol Hepatol. 2010;22(1):24–32.

    CrossRef  PubMed  CAS  Google Scholar 

  45. Day CP, James OF. Steatohepatitis: a tale of two “hits”? Gastroenterology. 1998;114(4):842–5.

    CrossRef  CAS  PubMed  Google Scholar 

  46. Tilg H, Moschen AR. Evolution of inflammation in nonalcoholic fatty liver disease: the multiple parallel hits hypothesis. Hepatology. 2010;52(5):1836–46.

    CrossRef  CAS  PubMed  Google Scholar 

  47. Jacome-Sosa MM, Parks EJ. Fatty acid sources and their fluxes as they contribute to plasma triglyceride concentrations and fatty liver in humans. Curr Opin Lipidol. 2014;25(3):213–20.

    CrossRef  CAS  PubMed  Google Scholar 

  48. Neuschwander-Tetri BA. Hepatic lipotoxicity and the pathogenesis of nonalcoholic steatohepatitis: the central role of nontriglyceride fatty acid metabolites. Hepatology. 2010;52(2):774–88.

    CrossRef  PubMed  CAS  Google Scholar 

  49. Seki S, Kitada T, Sakaguchi H. Clinicopathological significance of oxidative cellular damage in non-alcoholic fatty liver diseases. Hepatol Res. 2005;33(2):132–4.

    CrossRef  CAS  PubMed  Google Scholar 

  50. Buzzetti E, Pinzani M, Tsochatzis EA. The multiple-hit pathogenesis of non-alcoholic fatty liver disease (NAFLD). Metabolism. 2016;65(8):1038–48.

    CrossRef  CAS  PubMed  Google Scholar 

  51. Pessayre D. Mitochondrial injury in steatohepatitis. Eur J Gastroenterol Hepatol. 2004;16(11):1095–105.

    CrossRef  CAS  PubMed  Google Scholar 

  52. Begriche K, Igoudjil A, Pessayre D, Fromenty B. Mitochondrial dysfunction in NASH: causes, consequences and possible means to prevent it. Mitochondrion. 2006;6(1):1–28.

    CrossRef  CAS  PubMed  Google Scholar 

  53. Cusi K. Nonalcoholic fatty liver disease in type 2 diabetes mellitus. Curr Opin Endocrinol Diabetes Obes. 2009;16(2):141–9.

    CrossRef  PubMed  Google Scholar 

  54. Cusi K. Role of obesity and lipotoxicity in the development of nonalcoholic steatohepatitis: pathophysiology and clinical implications. Gastroenterology. 2012;142(4):711–725.e6.

    CrossRef  CAS  PubMed  Google Scholar 

  55. Hotamisligil GS, Shargill NS, Spiegelman BM. Adipose expression of tumor necrosis factor-alpha: direct role in obesity-linked insulin resistance. Science. 1993;259(5091):87–91.

    CrossRef  CAS  PubMed  Google Scholar 

  56. Sun K, Kusminski CM, Scherer PE. Adipose tissue remodeling and obesity. J Clin Invest. 2011;121(6):2094–101.

    CrossRef  CAS  PubMed  PubMed Central  Google Scholar 

  57. Rosen ED, Spiegelman BM. What we talk about when we talk about fat. Cell. 2014;156(0):20–44.

    CrossRef  CAS  PubMed  PubMed Central  Google Scholar 

  58. Cinti S, Mitchell G, Barbatelli G, Murano I, Ceresi E, Faloia E, et al. Adipocyte death defines macrophage localization and function in adipose tissue of obese mice and humans. J Lipid Res. 2005;46(11):2347–55.

    CrossRef  CAS  PubMed  Google Scholar 

  59. Xu H, Barnes GT, Yang Q, Tan G, Yang D, Chou CJ, et al. Chronic inflammation in fat plays a crucial role in the development of obesity-related insulin resistance. J Clin Invest. 2003;112(12):1821–30.

    CrossRef  CAS  PubMed  PubMed Central  Google Scholar 

  60. Henegar C, Tordjman J, Achard V, Lacasa D, Cremer I, Guerre-Millo M, et al. Adipose tissue transcriptomic signature highlights the pathological relevance of extracellular matrix in human obesity. Genome Biol. 2008;9(1):R14.

    CrossRef  PubMed  PubMed Central  CAS  Google Scholar 

  61. Landgraf K, Rockstroh D, Wagner IV, Weise S, Tauscher R, Schwartze JT, et al. Evidence of early alterations in adipose tissue biology and function and its association with obesity-related inflammation and insulin resistance in children. Diabetes. 2015;64(4):1249–61.

    CrossRef  CAS  PubMed  Google Scholar 

  62. Abdennour M, Reggio S, Le Naour G, Liu Y, Poitou C, Aron-Wisnewsky J, et al. Association of adipose tissue and liver fibrosis with tissue stiffness in morbid obesity: links with diabetes and BMI loss after gastric bypass. J Clin Endocrinol Metab. 2014;99(3):898–907.

    CrossRef  CAS  PubMed  Google Scholar 

  63. Kanda H, Tateya S, Tamori Y, Kotani K, Hiasa K, Kitazawa R, et al. MCP-1 contributes to macrophage infiltration into adipose tissue, insulin resistance, and hepatic steatosis in obesity. J Clin Invest. 2006;116(6):1494–505.

    CrossRef  CAS  PubMed  PubMed Central  Google Scholar 

  64. Wellen KE. Inflammation, stress, and diabetes. J Clin Invest. 2005;115(5):1111–9.

    CrossRef  CAS  PubMed  PubMed Central  Google Scholar 

  65. Stinkens R, Goossens GH, Jocken JWE, Blaak EE. Targeting fatty acid metabolism to improve glucose metabolism. Obes Rev. 2015;16(9):715–57.

    CrossRef  CAS  PubMed  Google Scholar 

  66. Fernandez-Real JM, Vayreda M, Richart C, Gutierrez C, Broch M, Vendrell J, et al. Circulating interleukin 6 levels, blood pressure, and insulin sensitivity in apparently healthy men and women. J Clin Endocrinol Metab. 2001;86(3):1154–9.

    CrossRef  CAS  PubMed  Google Scholar 

  67. Iyengar NM, Hudis CA, Dannenberg AJ. Obesity and cancer: local and systemic mechanisms. Annu Rev Med. 2015;66:297–309.

    CrossRef  CAS  PubMed  Google Scholar 

  68. van der Poorten D, Milner K-L, Hui J, Hodge A, Trenell MI, Kench JG, et al. Visceral fat: a key mediator of steatohepatitis in metabolic liver disease. Hepatology. 2008;48(2):449–57.

    CrossRef  PubMed  Google Scholar 

  69. Cancello R, Tordjman J, Poitou C, Guilhem G, Bouillot JL, Hugol D, et al. Increased infiltration of macrophages in omental adipose tissue is associated with marked hepatic lesions in morbid human obesity. Diabetes. 2006;55(6):1554–61.

    CrossRef  CAS  PubMed  Google Scholar 

  70. Tordjman J, Poitou C, Hugol D, Bouillot J-L, Basdevant A, Bedossa P, et al. Association between omental adipose tissue macrophages and liver histopathology in morbid obesity: influence of glycemic status. J Hepatol. 2009;51(2):354–62.

    CrossRef  CAS  PubMed  Google Scholar 

  71. du Plessis J, van Pelt J, Korf H, Mathieu C, van der Schueren B, Lannoo M, et al. Association of adipose tissue inflammation with histologic severity of nonalcoholic fatty liver disease. Gastroenterology. 2015;149(3):635–648.e14.

    CrossRef  PubMed  CAS  Google Scholar 

  72. Aleffi S, Navari N, Delogu W, Galastri S, Novo E, Rombouts K, et al. Mammalian target of rapamycin mediates the angiogenic effects of leptin in human hepatic stellate cells. Am J Physiol Gastrointest Liver Physiol. 2011;301(2):G210–9.

    CrossRef  CAS  PubMed  Google Scholar 

  73. Choi SS, Syn W-K, Karaca GF, Omenetti A, Moylan CA, Witek RP, et al. Leptin promotes the myofibroblastic phenotype in hepatic stellate cells by activating the hedgehog pathway. J Biol Chem. 2010;285(47):36551–60.

    CrossRef  CAS  PubMed  PubMed Central  Google Scholar 

  74. Kamada Y, Tamura S, Kiso S, Matsumoto H, Saji Y, Yoshida Y, et al. Enhanced carbon tetrachloride-induced liver fibrosis in mice lacking adiponectin. Gastroenterology. 2003;125(6):1796–807.

    CrossRef  CAS  PubMed  Google Scholar 

  75. Tilg H, Hotamisligil GS. Nonalcoholic fatty liver disease: cytokine-adipokine interplay and regulation of insulin resistance. Gastroenterology. 2006;131(3):934–45.

    CrossRef  CAS  PubMed  Google Scholar 

  76. Wigg A, Roberts-Thomson I, Dymock R, McCarthy P, Grose R, Cummins A. The role of small intestinal bacterial overgrowth, intestinal permeability, endotoxaemia, and tumour necrosis factor α in the pathogenesis of non-alcoholic steatohepatitis. Gut. 2001;48(2):206–11.

    CrossRef  CAS  PubMed  PubMed Central  Google Scholar 

  77. Moschen AR, Kaser S, Tilg H. Non-alcoholic steatohepatitis: a microbiota-driven disease. Trends Endocrinol Metab. 2013;24(11):537–45.

    CrossRef  CAS  PubMed  Google Scholar 

  78. Miele L, Valenza V, La Torre G, Montalto M, Cammarota G, Ricci R, et al. Increased intestinal permeability and tight junction alterations in nonalcoholic fatty liver disease. Hepatology. 2009;49(6):1877–87.

    CrossRef  CAS  PubMed  Google Scholar 

  79. de Alwis NMW, Anstee QM, Day CP. How to diagnose nonalcoholic fatty liver disease. Dig Dis. 2016;34(Suppl. 1):19–26.

    CrossRef  PubMed  Google Scholar 

  80. 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.

    CrossRef  CAS  PubMed  Google Scholar 

  81. Ekstedt M, Hagström H, Nasr P, Fredrikson M, Stål P, Kechagias S, et al. Fibrosis stage is the strongest predictor for disease-specific mortality in NAFLD after up to 33 years of follow-up. Hepatology. 2015;61(5):1547–54.

    CrossRef  CAS  PubMed  Google Scholar 

  82. Angulo P, Kleiner DE, Dam-Larsen S, Adams LA, Bjornsson ES, Charatcharoenwitthaya P, et al. Liver fibrosis, but no other histologic features, associates with long-term outcomes of patients with nonalcoholic fatty liver disease. Gastroenterology. 2015;149(2):389–97.e10.

    CrossRef  PubMed  Google Scholar 

  83. Hernaez R, Lazo M, Bonekamp S, Kamel I, Brancati FL, Guallar E, et al. Diagnostic accuracy and reliability of ultrasonography for the detection of fatty liver: a meta-analysis. Hepatology. 2011;54(3):1082–90.

    CrossRef  PubMed  Google Scholar 

  84. Fishbein M, Castro F, Cheruku S, Jain S, Webb B, Gleason T, et al. Hepatic MRI for fat quantitation: its relationship to fat morphology, diagnosis, and ultrasound. J Clin Gastroenterol. 2005;39(7):619–25.

    CrossRef  PubMed  Google Scholar 

  85. Tang A, Desai A, Hamilton G, Wolfson T, Gamst A, Lam J, et al. Accuracy of MR imaging–estimated proton density fat fraction for classification of dichotomized histologic steatosis grades in nonalcoholic fatty liver disease. Radiology. 2015;274(2):416–25.

    CrossRef  PubMed  Google Scholar 

  86. Runge JH, Smits LP, Verheij J, Depla A, Kuiken SD, Baak BC, et al. MR spectroscopy–derived proton density fat fraction is superior to controlled attenuation parameter for detecting and grading hepatic steatosis. Radiology. 2017;15:162931.

    Google Scholar 

  87. Bedossa P, Patel K. Biopsy and noninvasive methods to assess progression of nonalcoholic fatty liver disease. Gastroenterology. 2016;150(8):1811–1822.e4.

    CrossRef  PubMed  Google Scholar 

  88. Wong VW, Vergniol J, Wong GL, Foucher J, Chan HL, Le Bail B, Choi PC, Kowo M, Chan AW, Merrouche W, Sung JJ, de Lédinghen V. Diagnosis of fibrosis and cirrhosis using liver stiffness measurement in nonalcoholic fatty liver disease. Hepatology. 2010;51(2):454–62. Wiley Online Library [Internet]. [cited 2017 Oct 10]. Available from: http://onlinelibrary.wiley.com.ep.fjernadgang.kb.dk/doi/10.1002/hep.23312/full

    CrossRef  CAS  PubMed  Google Scholar 

  89. Wong VW-S, Vergniol J, Wong GL-H, Foucher J, Chan AW-H, Chermak F, et al. Liver stiffness measurement using XL probe in patients with nonalcoholic fatty liver disease. Am J Gastroenterol. 2012;107(12):1862–71.

    CrossRef  PubMed  Google Scholar 

  90. Angulo P, Hui JM, Marchesini G, Bugianesi E, George J, Farrell GC, et al. The NAFLD fibrosis score: a noninvasive system that identifies liver fibrosis in patients with NAFLD. Hepatology. 2007;45(4):846–54.

    CrossRef  CAS  PubMed  Google Scholar 

  91. Shah AG, Lydecker A, Murray K, Tetri BN, Contos MJ, Sanyal AJ, et al. Comparison of noninvasive markers of fibrosis in patients with nonalcoholic fatty liver disease. Clin Gastroenterol Hepatol. 2009;7(10):1104–12.

    CrossRef  CAS  PubMed  PubMed Central  Google Scholar 

  92. Guidelines [Internet]. [cited 2017 Oct 12]. Available from: http://www.dsgh.dk/guidelines

  93. Ludwig J, Viggiano TR, McGill DB, Oh BJ. Nonalcoholic steatohepatitis: Mayo Clinic experiences with a hitherto unnamed disease. Mayo Clin Proc. 1980;55(7):434–8.

    CAS  PubMed  Google Scholar 

  94. Brunt EM, Janney CG, Di Bisceglie AM, Neuschwander-Tetri BA, Bacon BR. Nonalcoholic steatohepatitis: a proposal for grading and staging the histological lesions. Am J Gastroenterol. 1999;94(9):2467–74.

    CrossRef  CAS  PubMed  Google Scholar 

  95. Kleiner DE, Brunt EM, Van Natta M, Behling C, Contos MJ, Cummings OW, et al. Design and validation of a histological scoring system for nonalcoholic fatty liver disease. Hepatology. 2005;41(6):1313–21.

    CrossRef  PubMed  Google Scholar 

  96. Bedossa P, the FLIP Pathology Consortium. Utility and appropriateness of the fatty liver inhibition of progression (FLIP) algorithm and steatosis, activity, and fibrosis (SAF) score in the evaluation of biopsies of nonalcoholic fatty liver disease. Hepatology. 2014;60(2):565–75.

    CrossRef  CAS  PubMed  Google Scholar 

  97. Bedossa P. Histological assessment of NAFLD. Dig Dis Sci. 2016;61(5):1348–55.

    CrossRef  CAS  PubMed  Google Scholar 

  98. Hagström H, Nasr P, Ekstedt M, Hammar U, Stål P, Hultcrantz R, et al. Fibrosis stage but not NASH predicts mortality and time to development of severe liver disease in biopsy-proven NAFLD. J Hepatol. 2017;67(6):1265–73.

    CrossRef  PubMed  Google Scholar 

  99. Pais R, Charlotte F, Fedchuk L, Bedossa P, Lebray P, Poynard T, et al. A systematic review of follow-up biopsies reveals disease progression in patients with non-alcoholic fatty liver. J Hepatol. 2013;59(3):550–6.

    CrossRef  CAS  PubMed  Google Scholar 

  100. Ekstedt M, Franzén 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(4):865–73.

    CrossRef  CAS  PubMed  Google Scholar 

  101. Adams LA, Sanderson S, Lindor KD, Angulo P. The histological course of nonalcoholic fatty liver disease: a longitudinal study of 103 patients with sequential liver biopsies. J Hepatol. 2005;42(1):132–8.

    CrossRef  PubMed  Google Scholar 

  102. Wong VW-S, Wong GL-H, Choi PC-L, Chan AW-H, Li MK-P, Chan H-Y, et al. Disease progression of non-alcoholic fatty liver disease: a prospective study with paired liver biopsies at 3 years. Gut. 2010;59(7):969–74.

    CrossRef  PubMed  Google Scholar 

  103. McPherson S. Evidence of NAFLD progression from steatosis to fibrosing-steatohepatitis using paired biopsies: implications for prognosis and clinical management. J Hepatol. 2015;62(5):1148–55.

    CrossRef  PubMed  Google Scholar 

  104. Calzadilla Bertot L, Adams LA. The natural course of non-alcoholic fatty liver disease. Int J Mol Sci [Internet]. 2016;17(5). Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4881593/

    CrossRef  PubMed Central  CAS  Google Scholar 

  105. 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(4):643–654.e1–9. quiz e39–40

    CrossRef  PubMed  Google Scholar 

  106. Teli MR, James OFW, Burt AD, Bennett MK, Day CP. The natural history of nonalcoholic fatty liver: a follow-up study. Hepatology. 1995;22(6):1714–9.

    CrossRef  CAS  PubMed  Google Scholar 

  107. Matteoni CA, Younossi ZM, Gramlich T, Boparai N, Liu YC, McCullough AJ. Nonalcoholic fatty liver disease: a spectrum of clinical and pathological severity. Gastroenterology. 1999;116(6):1413–9.

    CrossRef  CAS  PubMed  Google Scholar 

  108. Torres DM, Williams CD, Harrison SA. Features, diagnosis, and treatment of nonalcoholic fatty liver disease. Clin Gastroenterol Hepatol. 2012;10(8):837–58.

    CrossRef  PubMed  Google Scholar 

  109. Agopian VG, Kaldas FM, Hong JC, Whittaker M, Holt C, Rana A, et al. Liver transplantation for nonalcoholic steatohepatitis: the new epidemic. Ann Surg. 2012;256(4):624–33.

    CrossRef  PubMed  Google Scholar 

  110. Dyson J, Jaques B, Chattopadyhay D, Lochan R, Graham J, Das D, et al. Hepatocellular cancer: the impact of obesity, type 2 diabetes and a multidisciplinary team. J Hepatol. 2014;60(1):110–7.

    CrossRef  PubMed  Google Scholar 

  111. Yasui K, Hashimoto E, Komorizono Y, Koike K, Arii S, Imai Y, et al. Characteristics of patients with nonalcoholic steatohepatitis who develop hepatocellular carcinoma. Clin Gastroenterol Hepatol. 2011;9(5):428–33. quiz e50

    CrossRef  PubMed  Google Scholar 

  112. Ertle J, Dechêne A, Sowa J-P, Penndorf V, Herzer K, Kaiser G, et al. Non-alcoholic fatty liver disease progresses to hepatocellular carcinoma in the absence of apparent cirrhosis. Int J Cancer. 2011;128(10):2436–43.

    CrossRef  CAS  PubMed  Google Scholar 

  113. Cobble M, Bale B. Carotid intima-media thickness: knowledge and application to everyday practice. Postgrad Med. 2010;122(1):10–8.

    CrossRef  PubMed  Google Scholar 

  114. Desai CS, Ning H, Kang J, Folsom AR, Polak JF, Sibley CT, et al. Competing cardiovascular outcomes associated with subclinical atherosclerosis (from the multi-ethnic study of atherosclerosis). Am J Cardiol. 2013;111(11):1541–6.

    CrossRef  PubMed  PubMed Central  Google Scholar 

  115. Sookoian S, Pirola CJ. Non-alcoholic fatty liver disease is strongly associated with carotid atherosclerosis: a systematic review. J Hepatol. 2008;49(4):600–7.

    CrossRef  PubMed  Google Scholar 

  116. Oni ET, Agatston AS, Blaha MJ, Fialkow J, Cury R, Sposito A, et al. A systematic review: burden and severity of subclinical cardiovascular disease among those with nonalcoholic fatty liver; should we care? Atherosclerosis. 2013;230(2):258–67.

    CrossRef  CAS  PubMed  Google Scholar 

  117. Brea A, Mosquera D, Martín E, Arizti A, Cordero JL, Ros E. Nonalcoholic fatty liver disease is associated with carotid atherosclerosis: a case-control study. Arterioscler Thromb Vasc Biol. 2005;25(5):1045–50.

    CrossRef  CAS  PubMed  Google Scholar 

  118. 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(6):1244–9.

    CrossRef  CAS  PubMed  Google Scholar 

  119. Salvi P, Ruffini R, Agnoletti D, Magnani E, Pagliarani G, Comandini G, et al. Increased arterial stiffness in nonalcoholic fatty liver disease: the cardio-GOOSE study. J Hypertens. 2010;28(8):1699–707.

    CrossRef  CAS  PubMed  Google Scholar 

  120. Thakur ML, Sharma S, Kumar A, Bhatt SP, Luthra K, Guleria R, et al. Nonalcoholic fatty liver disease is associated with subclinical atherosclerosis independent of obesity and metabolic syndrome in Asian Indians. Atherosclerosis. 2012;223(2):507–11.

    CrossRef  CAS  PubMed  Google Scholar 

  121. Villanova N, Moscatiello S, Ramilli S, Bugianesi E, Magalotti D, Vanni E, et al. Endothelial dysfunction and cardiovascular risk profile in nonalcoholic fatty liver disease. Hepatology. 2005;42(2):473–80.

    CrossRef  PubMed  Google Scholar 

  122. Mohammadi A, Sedani HH, Ghasemi-Rad M. Evaluation of carotid intima-media thickness and flow-mediated dilatation in middle-aged patients with nonalcoholic fatty liver disease. Vasc Health Risk Manag. 2011;7:661–5.

    PubMed  PubMed Central  Google Scholar 

  123. Vanwagner LB, Wilcox JE, Colangelo LA, Lloyd-Jones DM, Carr JJ, Lima JA, et al. Association of nonalcoholic fatty liver disease with subclinical myocardial remodeling and dysfunction: a population-based study. Hepatology. 2015;62(3):773–83.

    CrossRef  CAS  PubMed  Google Scholar 

  124. Mantovani A, Pernigo M, Bergamini C, Bonapace S, Lipari P, Pichiri I, et al. Nonalcoholic fatty liver disease is independently associated with early left ventricular diastolic dysfunction in patients with type 2 diabetes. PLoS One. 2015;10(8):e0135329.

    CrossRef  PubMed  PubMed Central  CAS  Google Scholar 

  125. Bonci E, Chiesa C, Versacci P, Anania C, Silvestri L, Pacifico L. Association of nonalcoholic fatty liver disease with subclinical cardiovascular changes: a systematic review and meta-analysis. Biomed Res Int. 2015;2015:213737.

    CrossRef  PubMed  PubMed Central  Google Scholar 

  126. Petersen KF, Dufour S, Befroy D, Lehrke M, Hendler RE, Shulman GI. Reversal of nonalcoholic hepatic steatosis, hepatic insulin resistance, and hyperglycemia by moderate weight reduction in patients with type 2 diabetes. Diabetes. 2005;54(3):603–8.

    CrossRef  CAS  PubMed  Google Scholar 

  127. 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):367–378.e5.

    CrossRef  PubMed  Google Scholar 

  128. 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.

    CrossRef  CAS  PubMed  Google Scholar 

  129. Keating SE, Hackett DA, George J, Johnson NA. Exercise and non-alcoholic fatty liver disease: a systematic review and meta-analysis. J Hepatol. 2012;57(1):157–66.

    CrossRef  CAS  PubMed  Google Scholar 

  130. Keating SE, George J, Johnson NA. The benefits of exercise for patients with non-alcoholic fatty liver disease. Expert Rev Gastroenterol Hepatol. 2015;9(10):1247–50.

    CrossRef  CAS  PubMed  Google Scholar 

  131. Lassailly G, Caiazzo R, Buob D, Pigeyre M, Verkindt H, Labreuche J, et al. Bariatric surgery reduces features of nonalcoholic steatohepatitis in morbidly obese patients. Gastroenterology. 2015;149(2):379–88. quiz e15–16

    CrossRef  PubMed  Google Scholar 

  132. Caiazzo R, Lassailly G, Leteurtre E, Baud G, Verkindt H, Raverdy V, et al. Roux-en-Y gastric bypass versus adjustable gastric banding to reduce nonalcoholic fatty liver disease: a 5-year controlled longitudinal study. Ann Surg. 2014;260(5):893–8. discussion 898–9

    CrossRef  PubMed  Google Scholar 

  133. Sanyal AJ, Friedman SL, McCullough AJ, Dimick-Santos L. American Association for the Study of Liver Diseases, United States Food and Drug Administration. Challenges and opportunities in drug and biomarker development for nonalcoholic steatohepatitis: findings and recommendations from an American Association for the Study of Liver Diseases-U.S. Food and Drug Administration Joint Workshop. Hepatology. 2015;61(4):1392–405.

    CrossRef  PubMed  Google Scholar 

  134. Miller ER, Pastor-Barriuso R, Dalal D, Riemersma RA, Appel LJ, Guallar E. Meta-analysis: high-dosage vitamin E supplementation may increase all-cause mortality. Ann Intern Med. 2005;142(1):37–46.

    CrossRef  CAS  PubMed  Google Scholar 

  135. Bjelakovic G, Nikolova D, Gluud LL, Simonetti RG, Gluud C. Mortality in randomized trials of antioxidant supplements for primary and secondary prevention: systematic review and meta-analysis. JAMA. 2007;297(8):842–57.

    CrossRef  CAS  PubMed  Google Scholar 

  136. Klein EA, Thompson IM, Tangen CM, Crowley JJ, Lucia MS, Goodman PJ, et al. Vitamin E and the risk of prostate cancer: the Selenium and Vitamin E Cancer Prevention Trial (SELECT). JAMA. 2011;306(14):1549–56.

    CrossRef  CAS  PubMed  PubMed Central  Google Scholar 

  137. 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.

    CrossRef  CAS  PubMed  PubMed Central  Google Scholar 

  138. Boettcher E, Csako G, Pucino F, Wesley R, Loomba R. Meta-analysis: pioglitazone improves liver histology and fibrosis in patients with non-alcoholic steatohepatitis. Aliment Pharmacol Ther. 2012;35(1):66–75.

    CrossRef  CAS  PubMed  Google Scholar 

  139. Billington EO, Grey A, Bolland MJ. The effect of thiazolidinediones on bone mineral density and bone turnover: systematic review and meta-analysis. Diabetologia. 2015;58(10):2238–46.

    CrossRef  CAS  PubMed  Google Scholar 

  140. Tuccori M, Filion KB, Yin H, Yu OH, Platt RW, Azoulay L. Pioglitazone use and risk of bladder cancer: population based cohort study. BMJ. 2016;352:i1541.

    CrossRef  PubMed  PubMed Central  CAS  Google Scholar 

  141. Caldwell S. NASH therapy: omega 3 supplementation, vitamin E, insulin sensitizers and statin drugs. Clin Mol Hepatol. 2017;23(2):103–8.

    CrossRef  PubMed  PubMed Central  Google Scholar 

  142. 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.

    CrossRef  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Julie Steen Pedersen .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and Permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Pedersen, J.S., Bendtsen, F. (2019). Adult Non-alcoholic Fatty Liver Disease (NAFLD). In: Krag, A., Hansen, T. (eds) The Human Gut-Liver-Axis in Health and Disease. Springer, Cham. https://doi.org/10.1007/978-3-319-98890-0_2

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-98890-0_2

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-98889-4

  • Online ISBN: 978-3-319-98890-0

  • eBook Packages: MedicineMedicine (R0)