Non-alcoholic steatohepatitis (NASH) – every physician's concern

Authors: K. Dvořák
Authors‘ workplace: IV. interní klinika 1. LF UK a VFN v Praze
Published in: Gastroent Hepatol 2012; 66(5): 377-383
Category: Hepatology: Review article


Non-alcoholic steatohepatitis (NASH) has undergone turbulent development in the last 30 years, becoming the most common chronic liver disease in the western world. The relationship of NASH with obesity and particularly with insulin resistance was crucial in pathogenesis understanding; nowadays non-alcoholic steatohepatitis is considered to be an integral part of the metabolic syndrome. It represents a serious socioeconomic issue with a prevalence of 20–30% in overweight or obese people. NASH may exist individually or in coincidence with other liver diseases, thus complicating their course. NASH is routinely diagnosed using liver ultrasound and elevated liver enzymes; however, this probably leads to significant underdiagnosing. There is no proven effective pharmacological treatment yet; life-style changes like weight loss and increased physical activity are usually recommended. An increasing number of patients diagnosed with NASH are to be expected and an integrated interdisciplinary approach in their treatment will be necessary.

Key words:
steatohepatitis – obesity – technics and diagnostic procedures

The author declares he has no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE „uniform requirements“ for biomedical papers.

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1. Zelman S. The liver in obesity. Arch Intern Med 1958; 90(2): 141–156.

2. Peters RL, Gay T, Reynolds TB. Post-jejuno--ileal-bypass hepatic disease. Its similarity to alcoholic liver disease. Am J Clin Pathol 1975; 63(3): 318–331.

3. Ludwig J, Vigiano TR, McGill DB et al. Non­alcoholic steatohepatitis. Mayo Clinic expieriences with a hitherto unnamed disease. Mayo Clin Proc 1980; 55(7): 434–438.

4. Thaler H. Morphologische Befunde bei chronischer Alkoholintoxikation. In: Gerok W, Sickinger K, Hennkeuser HH (Eds). Alcohol and the Liver. Stuttgart: Schattauer Verlag 1971: 257–265.

5. Sanyal AJ, Campbell-Sargent C, Mirshahi F et al. Nonalcoholic steatohepatitis: association of insulin resistance and mitochondrial abnormalities. Gastroenterology 2001; 120(5): 1183–1192.

6. Marchesini G, Brizi M, Bianchi G et al. Nonalcoholic fatty liver disease: a feature of the metabolic syndrome. Diabetes 2001; 50(8): 1844–1850.

7. Marchesini G, Bugianesi E, Forlani G et al. Nonalcoholic fatty liver, steatohepatitis, and the metabolic syndrome. Hepatology 2003; 37(4): 917–923.

8. Angulo P. Nonalcoholic fatty liver disease. N Engl J Med 2002; 346(16): 1221–1231.

9. Adams LA, Sanderson S, Lindor KD et al. The histological course of nonalcoholic fatty liver disease: a longitudinal study of 103 patients with sequential liver biopsies. J Hepatol 2005; 42(1): 132–135.

10. Caldwell SH, Oelsner DH, Iezzoni JC et al. Cryptogenic cirrhosis: clinical characterization and risk factors for underlying disease. Hepatology 1999; 29(3): 664–669.

11. Ratziu V, Poynard T. Assesing the outcome of nonalcoholic steatohepatitis? It´s time to get serious. Hepatology 2006; 44(4): 802–805.

12. Ong JP, Pitts A, Younossi ZM. Increased overall mortality and liver-related mortality in non-alcoholic fatty liver disease. J Hepatol 2008; 49(4): 608–612.

13. Ertle J, Dechene A, Sowa JP et al. Non­alcoholic fatty liver disease progreses to hepatocelular carcinoma in absence of apparent cirrhosis. Int J Cancer 2011; 128(10): 2436–2443.

14. El-Serag HB, Hampel H, Javadi F. The association between diabetes and hepatocellular carcinoma: a systematic review of epidemiologic evidence. Clin Gastroenterol Hepatol 2006; 4(3): 369–380.

15. Marrero JA, Fontana RJ, Su GL. NAFLD may be a common underlying liver disease in patients with hepatocellular carcinoma in the United States. Hepatology 2002; 36(6): 1349–1354.

16. Clark JM, Brancati FL, Diehl AM. The prevalence and etiology of elevated aminotransferase levels in the United States. Am J Gastroenterol 2003; 98(5): 960–967.

17. Pendino GM, Mariano A, Surace P et al. Prevalence and etiology of altered liver tests: a population based survey in a Medierranean town. Hepatology 2005; 41(5): 1151–1159.

18. Bellentani S, Bedogni G, Miglioli L et al. The epidemiology of fatty liver. Eur J Gastro­enterol Hepatol 2004; 16(11): 1087–1093.

19. Hilden M, Christoffersen P, Juhl E et al. Liver histology in a ‚normal‘ population – examinations of 503 consecutive fatal traffic causalities. Scand J Gastroenterol 1977; 12(5): 593–597.

20. Pikhart H, Bobak M, Malyutina S et al. Obesity and education in three countries of the central and eastern Europe: The ­HAPIEE Study. Centr Eur J Public Health 2007; 15(4): 140–142.

21. Ueno T, Sugawara H, Sujaku K et al. Therapeutic effects of restricted diet and exercise in obese patients with fatty liver. J Hepatol 1997; 27(1): 103–107.

22. Thoma C, Day CP, Trenelli MI. Lifestyle interventions for the treatment of non-alcoholic fatty liver disease in adults: A systematic review. J Hepatol 2012; 56(1): 255–266.

23. Promrat K, Kleiner DE, Niemeier HM et al. Randomized controlled trial testing the effects of weight loss on non­alcoholic steatohepatitis. Hepatology 2010; 51(1): 121–129.

24. Boutelle K, Libbey H, Neumark-Sztai­ner D et al. Weight control strategies of overweight adolescents who succesfully lost weight. J Am Diet Assoc 2009; 109(12): 2029–2035.

25. Zelber-Sagi S, Nitzan-Kaluski D, Goldsmith R et al. Role of leisure time physical activity in nonalcoholic fatty liver disease: a population based study. Hepatology 2008; 48(6): 1791–1798.

26. Helmerhorst HJ, Wijndaele K, Brage S et al. Objectively measured sedentary time may predict insulin resistance independent of moderate- and vigorous-intensity physical activity. Diabetes 2009; 58(8): 1776–1779.

27. Harrison SA, Fecht W, Brunt EM et al. Orlistat for overweight subjects with non­alcoholic steatohepatitis: A roandomized prospective trial. Hepatology 2009; 49(1): 80–86.

28. Dixon JB, Bhathal PS, Hughes NR et al. Nonalcoholic fatty liver disease: Improvement in liver histological analysis with weight loss. Hepatology 2004; 39(6): 1647–1654.

29. Musso G, Gambino R, Cassader M et al. A meta-analysis of randomized trials for the treatment of nonalcoholic fatty liver disease. Hepatology 2010; 52(1): 79–104.

30. Galli A, Crabb DW, Ceni E et al. Anti­diabetic thiazolidinediones inhibit collagen synthesis and hepatic stellate cell activation in vivo and in vitro. Gastroenterology 2002; 122(7): 1924–1940.

31. Yilmaz Y, Atug O, Yonal O et al. Dipeptidyl peptidase IV inhibitors: therapeutic potential in nonalcoholic fatty liver disease. Med Sci Monit 2009; 15(4): 1–5.

32. Laurin J, Lindor K, Crippin J et al. Ursodeoxycholic acid or clofibrate in the treatment of nonalcoholic induced steatohepatitis: a pilot study. Hepatology 1996; 23(6): 1464–1467.

33. Browning J. Statins and hepatic steatosis: Perspectives from the Dallas Heart Study. Hepatology 2006; 44(2): 466–471.

34. Jin H, Yamamoto N, Uchida L et al. Telmisartan prevents hepatic fibrosis and enzyme-altered lesions in liver cirrhosis rat induced by a choline-deficient L-amino acid defined diet. Biochem Biophys Res Commun 2007; 364(4): 801–807.

35. Sanyal AJ. A randomized controlled trial of piglitazone or vitamin E for nonalcoholic steatohepatitis (PIVENS). N Engl J Med 2010; 362: 1675–1685.

36. Lindor K, Koowdley KV, Heathcote EJ et al. Urodeoxycholic acid fo treatment of non­alcoholic steatohepatitis: results of a randomized trial. Hepatology 2004; 39(3): 770–778.

37. De Alwis WN, Day CP. Current and future therapeutic strategies in NAFLD. Curr Pharm Des 2010; 16(17): 1958–1962.

Paediatric gastroenterology Gastroenterology and hepatology Surgery

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