Non-alcoholic Fatty Liver Disease Kevin Ang

NAFLD Fatty inflammation of liver: not due to excessive alcohol use Occurs when your liver has trouble breaking down fats, causing fat to build up in your liver tissue Related to insulin resistance and metabolic syndrome; exact cause is still unknown Cover a spectrum of disease activity. This spectrum begins as fatty accumulation in the liver (hepatic steatosis). and may respond to treatments originally developed for other insulin-resistant states (e.g. diabetes mellitus type 2), such as weight loss, metformin and thiazolidinediones.[1]

NAFLD Fatty accumulation in liver progresses to liver inflammation. When inflammation occurs in, the condition is then called NASH. Obesity and insulin resistance probably play a strong role in the disease process. Mechanisms of disease progression from one stage to the next are the subject of much research and debate. Oxidative stress, mitochondrial abnormalities and hormonal imbalances

Types of NAFLD Nonalcoholic fatty liver. Nonalcoholic steatohepatitis. simplest form; excess liver fat, but no complications. Very common. Nonalcoholic steatohepatitis. Liver fat causes inflammation: impairing the liver's ability to function; complications. Nonalcoholic fatty liver disease-associated cirrhosis. Liver inflammation leads to scarring. With time, scarring can become so severe that the liver no longer functions adequately (liver failure). Nonalcoholic fatty liver disease can take several forms — from harmless to life-threatening. Forms include:

NASH Non-alcoholic steatohepatitis: extreme form of NAFLD a major cause of liver cirrhosis of unknown cause First described at the Mayo Clinic (1980) Ludwig’s group described 20 obese, diabetic, non-alcoholic patients with similar findings to patients with alcoholic liver disease

Epidemiology Prevalence of NAFLD in Europe & US: 14-20% Increased prevalence: obesity epidemic plaguing the population In the US: NASH occurs in 3% of the general population Fibrosis due to NASH is seen in >40% of significantly obese patients

Treatment of NAFLD

Treatment Weight loss Exercise Orlistat (weight loss aid) Reversible inhibitor of gastric and pancreatic lipase Bariatric Surgery Pioglitazone, Rosiglitazone Antioxidants Vit. E supplementation Pioglitazone and Rosiglitazone are PPAR gamma inhibitors which improve insulin sensitivity within the adipocyte and skeletal muscle by upregulating specific protein kinases involved in decreasing fatty acid synthesis