Abstract
The term “Non-alcoholic fatty liver disease” (NAFLD) covers a series of liver lesions
similar to those induced by alcohol, but not caused by alcohol use. The importance
of NAFLD lies in the high prevalence in Western societies and, from the point of view
of the liver, in its progression from steatosis to cirrhosis and liver cancer. More
recently, NAFLD has been found to be associated with lipid metabolism disorders, the
deposition of fat outside of the adipocytes, insulin resistance and Metabolic Syndrome.
Also attributed to NAFLD is a heightened systemic pro-inflammatory state, which accelerates
arteriosclerosis, thereby increasing cardiovascular risk and associated cardiovascular
events. Here we provide an update to the etiopathogenesis of NAFLD, its influence
on cardiovascular disease, and the treatment options.
Keywords
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References
- Nonalcoholic steatohepatitis: summary of an AASLD Single Topic Conference.Hepatology. 2003; 37: 1202-1219
- The liver in obesity.AMA Arch Intern Med. 1952; 90: 141-156
- Nonalcoholic steatohepatitis: Mayo Clinic experiences with a hitherto unnamed disease.Mayo Clin Proc. 1980; 55: 434-438
- The natural history of nonalcoholic fatty liver disease: a population based cohort study.Gastroenterology. 2005; 129: 113-121
- Prevalence of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis among a largely middle-aged population utilizing ultrasound and liver biopsy: a prospective study.Gastroenterology. 2011; 140: 124-131
- Incidence and natural course of fatty liver in the general population: the Dionysos Study.Hepatology. 2007; 46: 1387-1391
- Prevalence of hepatic steatosis in an urban population in the United States: impact of ethnicity.Hepatology. 2004; 40: 1387-1395
- Prevalence of fatty liver in a general population of Okinawa Japan.Jpn J Med. 1988; 27: 142-149
- Gender, fatty liver and GGT.Hepatology. 2006; 44: 278-279
- Update on non-alcoholic fatty liver disease in children.Clin Nutr. 2007; 26: 409-415
- The epidemiology of nonalcoholic fatty liver disease: a global perspective.Semin Liver Dis. 2008; 28: 339-350
- Association of nonalcoholic fatty liver disease with insulin resistance.Am J Med. 1999; 107: 450-455
- Nonalcoholic fatty liver disease: predictors of nonalcoholic steatohepatitis and liver fibrosis in the severely obese.Gastroenterology. 2001; 121: 91-100
- Role of hepatic fat accumulation in pathogenesis of non-alcoholic fatty liver disease (NAFLD).Lipids Health Dis. 2010; 9: 42
- Contribution of adipose tissue and de novo lipogenesis to nonalcoholic fatty liver disease.J Clin Invest. 2005; 115: 1139-1142
- Sources of fatty acids stored in liver and secreted via lipoproteins in patients with nonalcoholic fatty liver disease.J Clin Invest. 2005; 115: 1343-1351
- Mechanisms of disease progression in nonalcoholic fatty liver disease.Semin Liver Dis. 2008; 28: 370-379
- Pathogenesis and management issues for non-alcoholic fatty liver disease.World J Gastroenterol. 2007; 13: 4539-4550
- Obesity, inflammation, and insulin resistance.Gastroenterology. 2007; 132: 2169-2180
- Dissociation of hepatic steatosis and insulin resistance in mice overexpressing DGAT in the liver.Cell Metab. 2007; 6: 69-78
- Suppression of diacylglycerol acyltransferase-2 (DGAT2), but not DGAT1, with antisense oligonucleotides reverses diet-induced hepatic steatosis and insulin resistance.J Biol Chem. 2007; 282: 22678-22688
- Storing up trouble: does accumulation of intramyocellular triglyceride protect skeletal muscle from insulin resistance?.Clin Exp Pharmacol Physiol. 2009; 36: 5-11
- Apolipoprotein synthesis in non-alcoholic steatohepatitis.Hepatology. 2002; 35: 898-904
- Association between microsomal triglyceride transfer protein gene polymorphism and the biological features of liver steatosis in patients with type II diabetes.Diabetologia. 2000; 43: 995-999
- Polymorphisms in microsomal triglyceride transfer protein: a link between liver disease and atherogenic postprandial lipid profile in NASH?.Hepatology. 2007; 45: 1097-1107
- Saturated fatty acids promote endoplasmic reticulum stress and liver injury in rats with hepatic steatosis.Endocrinology. 2006; 147: 943-951
- Endoplasmic reticulum stress is reduced in tissues of obese subjects after weight loss.Diabetes. 2009; 58: 693-700
- Disruption of LDL receptor gene in transgenic SREBP-1a mice unmasks hyperlipidemia resulting from production of lipid-rich VLDL.J Clin Invest. 1999; 103: 1067-1076
- Steatohepatitis: a tale of two hits?.Gastroenterology. 1998; 114: 842-845
- Hepatic triglyceride synthesis and nonalcoholic fatty liver disease.Curr Opin Lipidol. 2008; 19: 295-300
- Nonalcoholic fatty liver disease.N Engl J Med. 2002; 346: 1221-1231
- Liver fibrosis in overweight patients.Gastroenterology. 2000; 118: 1117-1123
- An overview of nonalcoholic steatohepatitis: past, present and future directions.J Gastrointestin Liver Dis. 2010; 19: 415-423
- Nonalcoholic steatohepatitis: association of insulin resistance and mitochondrial abnormalities.Gastroenterology. 2001; 120: 1183-1192
- Nonalcoholic fatty liver disease: a feature of the metabolic syndrome.Diabetes. 2001; 50: 1844-1850
- Increased intestinal permeability and tight junction alterations in nonalcoholic fatty liver disease.Hepatology. 2009; 49: 1877-1887
- Diet, commensals and the intestine as sources of pathogen-associated molecular patterns in atherosclerosis, type 2 diabetes and non-alcoholic fatty liver disease.Atherosclerosis. 2011; 216: 1-6
- Ninety patients with nonalcoholic steatohepatitis: insulin resistance, familial tendency and severity of disease.Am J Gastroenterol. 2001; 96: 2957-2961
- Microsomal triglyceride transfer protein gene polymorphism strongly influences circulating malondialdehyde-modified low-density lipoprotein.Metabolism. 2009 Sep; 58: 1306-1311
- Apolipoprotein C3 gene variants in nonalcoholic fatty liver disease.N Engl J Med. 2010; 362: 1082-1089
- Genome-wide association analysis identifies variants associated with nonalcoholic fatty liver disease that have distinct effects on metabolic traits.PLoS Genet. 2011; 7: e1001324
- Gene expression in obese patients with non-alcoholic steatohepatitis.Rev Esp Enferm Dig. 2008; 100: 212-218
- Noninvasive diagnosis and monitoring of nonalcoholic steatohepatitis: present and future.Hepatology. 2007; 46: 582-589
- Diagnosis of different liver fibrosis characteristics by blood tests in non-alcoholic fatty liver disease.Liver Int. 2010; 30: 1400-1402
- Non-invasive diagnosis of nonalcoholic fatty liver and nonalcoholic steatohepatitis.J Dig Dis. 2011; 12: 10-16
- Hepatitis C and nonalcoholic fatty liver disease.Semin Liver Dis. 2004; 24: 399-413
- Diagnosis of nonalcoholic fatty liver disease: invasive versus noninvasive.Semin Liver Dis. 2008; 28: 386-395
- A position statement on NAFLD/NASH based on the EASL 2009 special conference.J Hepatol. 2010; 53: 372-384
- Systematic review: the diagnosis and staging of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis.Aliment Pharmacol Ther. 2011; 33: 525-540
- The Fatty Liver Index: a simple and accurate predictor of hepatic steatosis in the general population.BMC Gastroenterol. 2006; 6: 33
- Abdominal ultrasound for diagnosis of nonalcoholic fatty liver disease (NAFLD).Am J Gastroenterol. 2007; 102: 2716-2717
- The role of bright liver echo pattern on ultrasound B-mode examination in the diagnosis of liver steatosis.Dig Liver Dis. 2006; 38: 485-489
- Non-invasive assessment and quantification of liver steatosis by ultrasound, computed tomography and magnetic resonance.J Hepatol. 2009; 51: 433-445
- Transient elastography for the diagnosis of liver fibrosis.Expert Rev Med Devices. 2010; 7: 811-823
- Screening for liver fibrosis by using FibroScan(®) and FibroTest in patients with diabetes.Dig Liver Dis. 2012; 44: 413-418
- Insulin resistance in nonalcoholic fatty liver disease.Atherosclerosis. 2002; 3 ([Abstract]): 80
- Serum lipids, lipoproteins and apolipoproteins levels in patients with nonalcoholic steatohepatitis.J Clin Gastroenterol. 2003; 37: 177-182
- Overproduction of large VLDL particles is driven by increased liver fat content in man.Diabetologia. 2006; 49: 755-765
- Fatty infiltration of liver in hyperlipidemic patients.Dig Dis Sci. 2000; 45: 1929-1934
- Fatty liver is associated with dyslipidemia and dysglycemia independent of visceral fat: the Framingham Heart Study.Hepatology. 2010; 51: 1979-1987
- Influence of hepatic steatosis (fatty liver) on severity and composition of dyslipidemia in type 2 diabetes.Diabetes Care. 2006; 29: 1845-1850
- Definition of metabolic syndrome. Report of the National Heart, Lung, and Blood Institute/American Heart Association Conference on Scientific Issues Related to Definition.Circulation. 2004; 109: 433-438
- Metabolic syndrome as a precursor of cardiovascular disease and type 2 diabetes mellitus.Circulation. 2005; 112: 3066-3072
- Nonalcoholic fatty liver, steatohepatitis, and the metabolic syndrome.Hepatology. 2003; 37: 917-923
- Non-alcoholic fatty liver disease: further expression of the metabolic syndrome.J Gastroenterol Hepatol. 2007; : 22293-22303
- The metabolic syndrome as a predictor of nonalcoholic fatty liver disease.Ann Intern Med. 2005; 143: 722-728
- Nonalcoholic fatty liver disease and the metabolic syndrome.Curr Opin Lipidol. 2005; 16: 421-427
- Fatty liver: a novel component of the metabolic syndrome.Arterioscler Thromb Vasc Biol. 2008; 28: 27-38
- Interrelationship between fatty liver and insulin resistance in the development of type 2 diabetes.J Clin Endocrinol Metab. 2011; 96: 1093-1097
- A prospective study of cholesterol, apolipoproteins, and the risk of myocardial infarction.N Engl J Med. 1991; 325: 373-381
- Is there a simple way to identify insulin-resistant individuals at increased risk of cardiovascular disease?.Am J Cardiol. 2005; 96: 399-404
- The inflamed liver and atherosclerosis: a link between histologic severity of nonalcoholic fatty liver disease and increased cardiovascular risk.Dig Dis Sci. 2010; 55: 2644-2650
- Cardiovascular risk in nonalcoholic fatty liver disease.Atherosclerosis. 2002; 3 ([Abstract]): 79
- Elevated serum alanine aminotransferase activity and calculated risk of coronary heart disease in the United States.Hepatology. 2006; 43: 1145-1151
- Fatty liver is associated with insulin resistance, risk of coronary heart disease, and early atherosclerosis in a large European population.Hepatology. 2009; 49: 1537-1544
- The severity of nonalcoholic fatty liver disease is associated with increased cardiovascular risk in a large cohort of non-obese Asian subjects.Atherosclerosis. 2009; 203: 581-586
- NASH predicts plasma inflammatory biomarkers independently of visceral fat in men.Obesity (Silver Spring). 2008; 16: 1394-1399
- High prevalence of metabolic complications in patients with non-alcoholic fatty liver disease.Scand J Gastroenterol. 2004; 39: 864-869
- Effects of nonalcoholic fatty liver disease on the development of metabolic disorders.J Gastroenterol Hepatol. 2007; 22: 1086-1091
- Non-alcoholic fatty liver disease is independently associated with an increased prevalence of chronic kidney disease and proliferative/laser treated retinopathy in type 2 diabetic patients.Diabetologia. 2008; 51: 444-450
- Nonalcoholic fatty liver disease is associated with carotid atherosclerosis: a case–control study.Arterioscler Thromb Vasc Biol. 2005; 25: 1045-1050
- Hepatic steatosis is associated with an increased risk of carotid atherosclerosis.World J Gastroenterol. 2005; 11: 1848-1853
- Relations between carotid artery wall thickness and liver histology in subjects with non-alcoholic fatty liver disease.Diabetes Care. 2006; 29: 1325-1330
- Relation of nonalcoholic hepatic steatosis to early carotid atherosclerosis in healthy men: role of visceral fat accumulation.Diabetes Care. 2004; 27: 2498-2500
- Carotid artery intima-media thickness in nonalcoholic fatty liver disease.Am J Med. 2008; 121: 72-78
- Non-alcoholic fatty liver disease is strongly associated with carotid atherosclerosis: a systematic review.J Hepatol. 2008; 49: 600-607
- Association between nonalcoholic fatty liver disease and coronary artery disease.Coron Artery Dis. 2007; 18: 433-436
- Presence of coronary plaques in patients with nonalcoholic fatty liver disease.Radiology. 2010; 254: 393-400
- Endothelial dysfunction and cardiovascular risk profile in nonalcoholic fatty liver disease.Hepatology. 2005; 42: 473-480
- Should nonalcoholic fatty liver disease be included in the definition of metabolic syndrome? A cross-sectional comparison with Adult Treatment Panel III criteria in nonobese nondiabetic subjects.Diabetes Care. 2008; 31: 562-568
- Cardiac abnormalities as a new manifestation of nonalcoholic fatty liver disease: echocardiographic and tissue Doppler imaging assessment.J Clin Gastroenterol. 2006; 40: 949-955
- Increased mediastinal fat and impaired left ventricular energy metabolism in young men with newly found fatty liver.Hepatology. 2008; 47: 51-58
- Sonographic fatty liver, overweight and ischaemic heart disease.World J Gastroenterol. 2005; 11: 4838-4842
- Nonalcoholic fatty liver disease and the coronary artery disease.Dig Dis Sci. 2011; 56: 35-45
- Increased prevalence of cardiovascular disease among type 2 diabetic patients with non-alcoholic fatty liver disease.Diabet Med. 2006; 23: 403-409
- High prevalence of coronary heart disease in type 2 diabetic patients with non-alcoholic fatty liver disease.Arch Med Res. 2009; 40: 571-575
- Fatty liver as a determinant of atherosclerosis.Hepatology. 2005; 42 ([Abstract]): 610A
- Gammaglutamyltransferase: determinants and association with mortality from ischemic heart disease and all causes.Am J Epidemiol. 1995; 142: 699-708
- Gamma-glutamyltransferase as a risk factor for cardiovascular disease mortality: an epidemiological investigation in a cohort of 163,944 Austrian adults.Circulation. 2005; 112: 2130-2137
- Serum gammaglutamyltransferase predicts non-fatal myocardial infarction and fatal coronary heart disease among 28,838 middle-aged men and women.Eur Heart J. 2006; 27: 2170-2176
- Alanine aminotransferase predicts coronary heart disease events: a 10-year follow-up of the Hoorn Study.Atherosclerosis. 2007; 191: 391-396
- Gamma glutamyltransferase and metabolic syndrome, cardiovascular disease, and mortality risk: the Framingham Heart Study.Arterioscler Thromb Vasc Biol. 2007; 27: 127-133
- Suspected nonalcoholic fatty liver disease and mortality risk in a population-based cohort study.Am J Gastroenterol. 2008; 103: 2263-2271
- Increased overall mortality and liver-related mortality in non-alcoholic fatty liver disease.J Hepatol. 2008; 49: 608-612
- Prognosis of patients with a diagnosis of fatty liver: a registry-based cohort study.Hepatogastroenterology. 2003; 50: 2101-2104
- Nonalcoholic fatty liver disease and risk of future cardiovascular events among type 2 diabetic patients.Diabetes. 2005; 54: 3541-3546
- Nonalcoholic fatty liver disease is independently associated with an increased incidence of cardiovascular events in type 2 diabetic patients.Diabetes Care. 2007; 30: 2119-2121
- Nonalcoholic fatty liver disease is a novel predictor of cardiovascular disease.World J Gastroenterol. 2007; 13: 1579-1584
- Nonalcoholic steatohepatitis: a study of 49 patients.Hum Pathol. 1989; 20: 594-598
- Nonalcoholic fatty liver disease: a spectrum of clinical and pathological severity.Gastroenterology. 1999; 116: 1413-1419
- Long-term follow-up of patients with NAFLD and elevated liver enzymes.Hepatology. 2006; 44: 865-873
- Long-term follow-up of patients with nonalcoholic fatty liver.Clin Gastroenterol Hepatol. 2009; 7: 234-238
- Similarities and differences in outcomes of cirrhosis due to non-alcoholic steatohepatitis and hepatitis C.Hepatology. 2006; 43: 682-689
- Nonalcoholic fatty liver disease increases risk of death among patients with diabetes: a community-based cohort study.Am J Gastroenterol. 2010; 105: 1567-1573
- Long term prognosis of fatty liver: risk of chronic liver disease and death.Gut. 2004; 53: 750-755
- Risk of cardiovascular disease in patients with nonalcoholic fatty liver disease.N Engl J Med. 2010; 363: 1341-1350
- Non-alcoholic fatty liver disease and increased risk of cardiovascular disease.Atherosclerosis. 2007; 191: 235-240
- Therapeutic effects of restricted diet and exercise in obese patients with fatty liver.J Hepatol. 1997; 27: 103-107
- Modest weight loss and physical activity in overweight patients with chronic liver disease results in sustained improvements in alanine aminotransferase, fasting insulin, and quality of life.Gut. 2004; 53: 413-419
- Effect of 6-month nutritional intervention on non-alcoholic fatty liver disease.Nutrition. 2010; 26: 1094-1099
- Effect of a 12-month intensive lifestyle intervention on hepatic steatosis in adults with type 2 diabetes.Diabetes Care. 2010; 33: 2156-2163
- Randomized controlled trial testing the effects of weight loss on nonalcoholic steatohepatitis.Hepatology. 2010; 51: 121-129
- Exercise and fat accumulation in the human liver.Curr Opin Lipidol. 2010; 21: 507-517
- Dietary fat content modifies liver fat in overweight nondiabetic subjects.J Clin Endocrinol Metab. 2005; 90: 2804-2809
- Omega-3 supplementation and non-alcoholic fatty liver disease: a systematic review and meta-analysis.J Hepatol. 2012; 56: 944-951
- Modest wine drinking and decreased prevalence of suspected nonalcoholic fatty liver disease.Hepatology. 2008; 47: 1947-1954
- Alcohol consumption is associated with progression of hepatic fibrosis in non-alcoholic fatty liver disease.Scand J Gastroenterol. 2009; 44: 366-374
- Surgically-induced weight loss significantly improves nonalcoholic fatty liver disease and the metabolic syndrome.Ann Surg. 2005; 242: 610-617
- Role of fatty acids in the pathogenesis of obesity and fatty liver: impact of bariatric surgery.Semin Liver Dis. 2008; 28: 407-426
- Hepatic effects of dietary weight loss in morbidly obese subjects.J Hepatol. 1991; 12: 224-229
- A pilot study of orlistat treatment in obese, non-alcoholic steatohepatitis patients.Aliment Pharmacol Ther. 2004; 20: 623-628
- Orlistat reverses fatty infiltration and improves hepatic fibrosis in obese patients with non-alcoholic steatohepatitis (NASH).Dig Dis Sci. 2007; 52: 2512-2519
- Metformin in non-alcoholic steatohepatitis.Lancet. 2001; 358: 893-894
- Metformin in the treatment of non-alcoholic steatohepatitis: a pilot open label trial.Aliment Pharmacol Ther. 2004; 20: 23-28
- A randomized controlled trial of metformin versus vitamin E or prescriptive diet in nonalcoholic fatty liver disease.Am J Gastroenterol. 2005; 100: 1082-1090
- Improved nonalcoholic steatohepatitis after 48 weeks of treatment with the PPAR-gamma ligand rosiglitazone.Hepatology. 2003; 38: 1008-1017
- A placebo-controlled trial of pioglitazone in subjects with nonalcoholic steatohepatitis.N Engl J Med. 2006; 355: 2297-2307
- Long-term efficacy of rosiglitazone in nonalcoholic steatohepatitis: results of the fatty liver improvement by rosiglitazone therapy (FLIRT-2) extension trial.Hepatology. 2010; 51: 445-453
- Meta-analysis: insulin sensitizers for the treatment of non-alcoholic steatohepatitis.Aliment Pharmacol Ther. 2010; 32: 1211-1221
- Insulin sensitizers in nonalcoholic fatty liver disease and steatohepatitis: current status.Adv Ther. 2009; 26: 893-907
- Sitagliptin as a novel treatment agent for non-alcoholic fatty liver disease patients with type 2 diabetes mellitus.Hepatogastroenterology. 2011; 58: 2103-2105
- Statins in non-alcoholic fatty liver disease and chronically elevated liver enzymes: a histopathological follow-up study.J Hepatol. 2007; 47: 135-141
- Patients with elevated liver enzymes are not at higher risk for statin hepatotoxicity.Gastroenterology. 2004; 126: 1287-1292
- Rosuvastatin as a novel treatment of non-alcoholic fatty liver disease in hyperlipidemic patients.Atherosclerosis. 2006 Jan; 184: 233-234
- 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. 2010; 376: 1916-1922
- A controlled trial of gemfibrozil in the treatment of patients with non-alcoholic steatohepatitis.J Hepatol. 1999; 31: 384
- Effect of multifactorial treatment on non-alcoholic fatty liver disease in metabolic syndrome: a randomised study.Curr Med Res Opin. 2006; 22: 873-883
- NPC1L1 inhibitor ezetimibe is a reliable therapeutic agent for non-obese patients with nonalcoholic fatty liver disease.Lipids Health Dis. 2010; 9: 29
- Efficacy of ezetimibe for the treatment of non-alcoholic steatohepatitis: an open-label, pilot study.Hepatol Res. 2010; 40: 613-621
- Efficacy of long-term ezetimibe therapy in patients with nonalcoholic fatty liver disease.J Gastroenterol. 2011; 46: 101-107
- Vitamin E and vitamin C treatment improves fibrosis in patients with nonalcoholic steatohepatitis.Am J Gastroenterol. 2003; 98: 2485-2490
- Pioglitazone, vitamin E, or placebo for nonalcoholic steatohepatitis.N Engl J Med. 2010; 362: 1675-1685
- Ursodeoxycholic acid for treatment of nonalcoholic steatohepatitis: results of a randomized trial.Hepatology. 2004; 39: 770-778
- Therapeutic efficacy of an angiotensinogen II receptor antagonist in patients with nonalcoholic steatohepatitis.Hepatology. 2004; 40: 1222-1225
- Beneficial effects of pentoxifylline on hepatic steatosis, fibrosis and necroinflammation in patients with non-alcoholic steatohepatitis.J Gastroenterol Hepatol. 2007; 22: 634-638
- Cilostazol ameliorates metabolic abnormalities with suppression of proinflammatory markers in db/db mouse model of type 2 diabetes via activation of peroxisome proliferator activated receptor gamma transcription.J Pharmacol Exp Ther. 2009; 329: 571-579
- VSL#3 probiotic treatment attenuates fibrosis without changes in steatohepatitis in a diet-induced nonalcoholic steatohepatitis model in mice.Hepatology. 2009; 49: 989-997
Article info
Publication history
Published online: November 12, 2012
Accepted:
September 15,
2012
Received in revised form:
May 26,
2012
Received:
January 12,
2012
Identification
Copyright
© 2012 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.