Non Alcoholic Fatty Liver Disease

A special issue of Medicina (ISSN 1648-9144).

Deadline for manuscript submissions: closed (30 June 2019) | Viewed by 6916

Special Issue Editor

Division of Hepatology and Pancreatology, Department of Internal Medicine, Aichi Medical University, Nagakute, Aichi 480-1195, Japan
Interests: nonalcoholic steatohepatitis; oxidative stress; hepatic fibrosis; diabetes mellitus; liver cirrhosis; hepatocellular carcinoma
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Special Issue Information

Dear Colleagues,

It is estimated that 25% of the adult population suffers from nonalcoholic fatty liver disease (NAFLD) worldwide. PNPNA3 G allele is more prevalent in Asians and Hispanics compared to Caucasians or Blacks. PNPNA3 G allele and body weight gain >10 kg in the adulthood are associated with development of NAFLD. Old age, diabetes mellitus (DM), PNPLA3 GG genotype, and advanced fibrosis (Brunt stage 3/4) are independently associated with hepatocarcinogenesis in NAFLD patients. In order to predict overall or liver-related mortality, it is important to identify advanced fibrosis in NAFLD patients. The AASLD practice guidance in 2018 recommend four noninvasive modalities to detect severe fibrosis, including NAFLD fibrosis score (NFS), FIB4 index, vibration-controlled transient elastography (VCTE), and MR elastography (MRE). NFS and FIB4 index are very useful to exclude advanced fibrosis. MRE has several advantages over VCTE, including diagnostic accuracy, high performance in obese patients, and reproducibility. Liver-related mortality was more prevalent in DM patients. T2DM is one of the most significant variables associated with advanced fibrosis in NAFLD. The prevalence of advanced fibrosis is estimated to be 7.1%-17.1% in the T2DM population by VCTE or MRE. Bariatric surgeries are promising also for NASH patients. Pharmacotherapies that should be indicated in NASH with fibrosis have never established. SGLT2 inhibitors or GLP-1 analogues are expected in NAFLD patients with T2DM, because these agents have also cardioprotective and renoprotective activities (EMPA-REG outcome, CANVAS program, and DECLARE study). SGLT2 inhibitors significantly reduced hepatic fat estimated by MRI in T2DM patients with NAFLD (LEAD trial and E-LIFT trial). Sub-analyses in phase 3 study of SGLT2 inhibitors showed significant reductions in ALT levels in T2DM patients. There are now a variety of drug pipelines in the treatment of NASH. Obeticholic acid (bile acid FXR ligand), elafibranor (PPARα/δ agonist), selonsertib (ASK1 inhibitor), and cenicriviroc (CCR2/5 antagonists) are now under development in phase 3. A phase 2 study of pemafibrate (a novel selective PPARα modulator), pegylated FGF-21, and semaglutide is now ongoing. This Special Issue will review current knowledge and future perspectives in the epidemiology, pathogenesis, diagnosis, treatment, and prognosis of NAFLD.

Prof. Dr. Yoshio Sumida
Guest Editor

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Keywords

  • NASH
  • hepatic fibrosis
  • PNPLA3
  • SGLT2 inhibitor
  • GLP-1 receptor agonist

Published Papers (1 paper)

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14 pages, 586 KiB  
Review
Dietary and Pharmacological Treatment of Nonalcoholic Fatty Liver Disease
by Anna Jeznach-Steinhagen, Joanna Ostrowska, Aneta Czerwonogrodzka-Senczyna, Iwona Boniecka, Urszula Shahnazaryan and Alina Kuryłowicz
Medicina 2019, 55(5), 166; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina55050166 - 20 May 2019
Cited by 34 | Viewed by 6047
Abstract
Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in the developed world. Simple hepatic steatosis is mild, but the coexistence of steatohepatitis (NASH) and fibrosis increases the risk of hepatocellular carcinoma. Proper dietary and pharmacological treatment is essential for [...] Read more.
Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in the developed world. Simple hepatic steatosis is mild, but the coexistence of steatohepatitis (NASH) and fibrosis increases the risk of hepatocellular carcinoma. Proper dietary and pharmacological treatment is essential for preventing NAFLD progression. The first-line treatment should include dietary intervention and increased physical activity. The diet should be based on the food pyramid, with a choice of products with low glycemic index, complex carbohydrates in the form of low-processed cereal products, vegetables, and protein-rich products. Usage of insulin-sensitizing substances, pro- and prebiotics, and vitamins should also be considered. Such a therapeutic process is intended to support both liver disease and obesity-related pathologies, including insulin resistance, diabetes, dyslipidemia, and blood hypertension. In the pharmacological treatment of NAFLD, apart from pioglitazone, there are new classes of antidiabetic drugs that are of value, such as glucagon-like peptide 1 analogs and sodium/glucose cotransporter 2 antagonists, while several other compounds that target different pathogenic pathways are currently being tested in clinical trials. Liver biopsies should only be considered when there is a lack of decline in liver enzymes after 6 months of the abovementioned treatment. Dietary intervention is recommended in all patients with NAFLD, while pharmacological treatment is recommended especially for those with NASH and showing significant fibrosis in a biopsy. Full article
(This article belongs to the Special Issue Non Alcoholic Fatty Liver Disease)
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