When the journey from obesity to cirrhosis takes an early start Vlad Ratziu, Giulio Marchesini  Journal of Hepatology  Volume 65, Issue 2, Pages 249-251 (August 2016) DOI: 10.1016/j.jhep.2016.05.021 Copyright © 2016 Terms and Conditions

Fig. 1 Descriptive diagram showing the interaction between genes and lifestyle in the development of excessive fat accumulation and liver-related outcomes in the course of life. For the sake of clarity, all cases are expected to start with normal body fat, but in a few cases in utero changes may also occur (babies born either small or large for gestational age), at high risk of future obesity or diabetes. Subjects may remain normal weight or minimally overweight throughout their life (green line), and will never intercept the level of liver disease (light orange area) or type 2 diabetes. Other individuals (brown line) will develop overweight or obesity during adulthood; they will intercept the level of liver disease and will develop NAFLD, at various stages of disease severity along the years (from pure fatty liver, to NASH, fibrosis, cirrhosis). The occurrence of type 2 diabetes will lower the threshold of their liver disease, as it lowers the threshold of liver-related death (dark orange area), in a time-dependent manner. In some cases, overweight or obesity might occur in early adulthood (red line), as in cases presented in the study by Hagström et al. In these cases, NASH is likely to occur early, and the threshold of liver-related death is reached at a relatively young age. Finally, in a few cases (blue line) overweight and obesity is present since childhood. In these cases, liver disease and liver-related death are anticipated further, with a remarkable reduction of life expectancy. Journal of Hepatology 2016 65, 249-251DOI: (10.1016/j.jhep.2016.05.021) Copyright © 2016 Terms and Conditions