Medical Book

Buy Textbooks | Autoclaves | stethoscopes | Buy Books Online | Buy Medical Textbooks | Textbooks | Equipment | Nutrition | USMLE | MRCP | MRCS | Dental | Sport Medicine | Cardiology | Medical Textbook | Surgery | Pregnancy | Anatomy | Radiation | Pedia |
HomeCalendarPublicationsFAQSearchMemberlistUsergroupsRegisterLog in


 Fatty Liver

View previous topic View next topic Go down 


Membership NO : 1
Male Posts : 1672
Join date : 2011-03-27

Fatty Liver  Empty
PostSubject: Fatty Liver    Fatty Liver  Icon_minitimeWed Jun 08, 2011 6:45 am

Fatty Liver
Dawn Sears, MD;
Chief Editor:
Julian Katz, MDBackground

Fatty liver disease can range from
fatty liver alone (steatosis) to fatty liver associated with
inflammation (steatohepatitis). This condition can occur with the use of
alcohol (alcohol-related fatty liver) or in the absence of alcohol
(nonalcoholic fatty liver disease [NAFLD]). Fatty liver disease
is now the most common cause for elevated liver function tests in the
United States. This is mainly due to the ongoing obesity epidemic in the
United States. Fatty liver can be associated with the use of
alcohol. This may occur with as little as 10 oz of alcohol ingested per
week. Identical lesions also can be caused by other diseases or toxins. If
steatohepatitis is present but a history of alcohol use is not, the
condition is termed nonalcoholic steatohepatitis (NASH). Fatty change in
the liver results from excessive accumulation of lipids within
hepatocytes. Simple fatty liver is believed to be benign, but NASH can
progress to cirrhosis and can be associated with hepatocellular carcinoma.
The main risk factors for simple fatty liver (NAFLD) and NASH are
obesity, diabetes, high triglyceride levels, or a high fat diet.
Fatty liver is the accumulation of
triglycerides and other fats in the liver cells. In some patients, this
may be accompanied by hepatic inflammation and liver cell death
(steatohepatitis). Potential pathophysiological mechanisms
include the following: (1) decreased mitochondrial fatty acid
beta-oxidation, (2) increased endogenous fatty acid synthesis or
enhanced delivery of fatty acids to the liver, and (3) deficient
incorporation or export of triglycerides as very low-density


United States
Steatosis affects approximately 25-35% of the
general population. Steatohepatitis may be related to alcohol-induced
hepatic damage or may be unrelated to alcohol (ie, NASH). NASH has been
detected in 1.2-9% of patients undergoing routine liver biopsy. NAFLD is
found in over 80% of patients who are obese. Over 50% of patients
undergoing bariatric surgery have NASH.International

and Australian studies show less intense disease progression than
studies in the United States. Asian studies reveal NASH and NAFLD at
lower body mass indexes (BMIs).Mortality/Morbidity

natural history study from Olmsted County, Minnesota, revealed that 10%
more patients with NAFLD died versus control subjects over a 10-year
period. Malignancy and heart disease were the top 2 causes of death.
Liver-related disease was the third cause of death (13%), as compared to
the 13th cause of death (< 1%) for control subjects.

  • Steatosis
    was once believed to be a benign condition, with rare progression to
    chronic liver disease. Steatohepatitis may progress to liver fibrosis
    and cirrhosis and may result in liver-related morbidity and mortality.
  • Fibrosis
    or cirrhosis in the liver is present in 15-50% of patients with NASH.
    Approximately 30% of patients with fibrosis develop cirrhosis after 10
    years. Many cases of cryptogenic cirrhosis may represent so-called
    burnt-out NASH because a high proportion is associated with obesity,
    type II diabetes, or hyperlipidemia.
  • Some
    patients with drug-induced fatty liver present dramatically with the
    rapid evolution of hepatic failure. Some patients with inborn errors of
    metabolism, such as tyrosinemia, may rapidly progress to cirrhosis.

Fatty liver has been found across all races, but most of the research and the highest prevalence appear in the Caucasian race. A
small study evaluating fatty liver disease in the Indian population
found its association with the nonobese and its recovery with simple
lifestyle habits.[3] However, obesity, when present, was a significant risk factor for NASH in Indians as well as in Koreans.[2] Interestingly,
and as supported in the author’s clinical practice, Asian patients
often develop NAFLD and NASH at normal BMIs, but BMIs on the higher
range for a patient’s ethnicity. A diagnosis of cirrhosis in an
80-year-old, 5-foot, 110-lb Asian female, with a BMI of 21, is not
unusual.Mutations for hemochromatosis appear to put Caucasians at a higher risk of more advanced fibrosis.[4] Sex

  • As many as 75% of patients in initial reported studies were females.
  • In more recent studies, 50% of patients are females.

  • Fatty liver occurs in all age groups.
    is the most common liver disease among adolescents in the United
    States. Older age often is predictive of more severe grading of
  • NASH is the third most common cause of
    chronic liver disease in adults in the United States (after hepatitis C
    and alcohol). It is now probably the leading reason for mild elevations
    of transaminases.
  • NASH has recurred within 6 months after pediatric or adult liver transplant.[5, 6, 7]
  • References
  • Chow WC, Tai ES, Lian SC, et al. Significant non-alcoholic
    fatty liver disease is found in non-diabetic, pre-obese Chinese in
    Singapore. Singapore Med J. Aug 2007;48(8):752-7. [Medline].
  • Park
    JW, Jeong G, Kim SJ, et al. Predictors reflecting the pathological
    severity of non-alcoholic fatty liver disease: comprehensive study of
    clinical and immunohistochemical findings in younger Asian patients. J Gastroenterol Hepatol. Apr 2007;22(4):491-7. [Medline].
  • Duseja
    A, Das A, Das R, et al. The clinicopathological profile of Indian
    patients with nonalcoholic fatty liver disease (NAFLD) is different from
    that in the West. Dig Dis Sci. Sep 2007;52(9):2368-74. [Medline].
  • Nelson
    JE, Bhattacharya R, Lindor KD, et al. HFE C282Y mutations are
    associated with advanced hepatic fibrosis in Caucasians with
    nonalcoholic steatohepatitis. Hepatology. Sep 2007;46(3):723-9. [Medline].
  • Jankowska. Recurrence of NASH after liver transplantation in a 13yo boy. Pediatr Transplant. Nov 2007;11:796-8.
  • Seo. De novo NAFLD after liver transplant. Liver Transpl. Jun 2007;13:844-7.
  • Yamamoto. NASH in donors for living donor liver transplantation. Transplantation. Feb 2007;83:257-62.
  • Degertekin
    B, Ozenirler S, Elbeg S, et al. The serum endothelin-1 level in
    steatosis and NASH, and its relation with severity of liver fibrosis. Dig Dis Sci. Oct 2007;52(10):2622-8. [Medline].
  • Shimada
    M, Kawahara H, Ozaki K, et al. Usefulness of a combined evaluation of
    the serum adiponectin level, HOMA-IR, and serum type IV collagen 7S
    level to predict the early stage of nonalcoholic steatohepatitis. Am J Gastroenterol. Sep 2007;102(9):1931-8. [Medline].
  • Garcia-Galiano
    D, Sanchez-Garrido MA, Espejo I, et al. IL-6 and IGF-1 are independent
    prognostic factors of liver steatosis and non-alcoholic steatohepatitis
    in morbidly obese patients. Obes Surg. Apr 2007;17(4):493-503. [Medline].
  • Yoneda
    M, Mawatari H, Fujita K, et al. High-sensitivity C-reactive protein is
    an independent clinical feature of nonalcoholic steatohepatitis (NASH)
    and also of the severity of fibrosis in NASH. J Gastroenterol. Jul 2007;42(7):573-82. [Medline].
  • Angulo
    P, Hui JM, Marchesini G, et al. The NAFLD fibrosis score: a noninvasive
    system that identifies liver fibrosis in patients with NAFLD. Hepatology. Apr 2007;45(4):846-54. [Medline].
  • [Best
    Evidence] Kotronen A, Peltonen M, Hakkarainen A, et al. Prediction of
    non-alcoholic fatty liver disease and liver fat using metabolic and
    genetic factors. Gastroenterology. Sep 2009;137(3):865-72. [Medline].
  • Kleiner
    DE, Brunt EM, Van Natta M, et al. Design and validation of a
    histological scoring system for nonalcoholic fatty liver disease. Hepatology. Jun 2005;41(6):1313-21. [Medline].
  • Takahashi
    Y, Iida K, Takahashi K, et al. Growth hormone reverses nonalcoholic
    steatohepatitis in a patient with adult growth hormone deficiency. Gastroenterology. Mar 2007;132(3):938-43. [Medline].
  • Yamamoto M, Iwasa M, Iwata K, et al. Restriction of dietary calories, fat and iron improves non-alcoholic fatty liver disease. J Gastroenterol Hepatol. Apr 2007;22(4):498-503. [Medline].
  • Tahan V, Eren F, Avsar E, et al. Rosiglitazone attenuates liver inflammation in a rat model of nonalcoholic steatohepatitis. Dig Dis Sci. Dec 2007;52(12):3465-72. [Medline].
  • Lutchman G, Modi A, Kleiner DE, et al. The effects of discontinuing pioglitazone in patients with nonalcoholic steatohepatitis. Hepatology. Aug 2007;46(2):424-9. [Medline].
  • Balas
    B, Belfort R, Harrison SA, et al. Pioglitazone treatment increases
    whole body fat but not total body water in patients with non-alcoholic
    steatohepatitis. J Hepatol. Oct 2007;47(4):565-70. [Medline].
  • Belfort
    R, Harrison SA, Brown K, et al. A placebo-controlled trial of
    pioglitazone in subjects with nonalcoholic steatohepatitis. N Engl J Med. Nov 30 2006;355(22):2297-307. [Medline].
  • Caldwell
    SH, Patrie JT, Brunt EM, et al. The effects of 48 weeks of
    rosiglitazone on hepatocyte mitochondria in human nonalcoholic
    steatohepatitis. Hepatology. Oct 2007;46(4):1101-7. [Medline].
  • Duseja
    A, Das A, Dhiman RK, et al. Metformin is effective in achieving
    biochemical response in patients with nonalcoholic fatty liver disease
    (NAFLD) not responding to lifestyle interventions. Ann Hepatol. Oct-Dec 2007;6(4):222-6. [Medline].
  • Georgescu
    EF, Georgescu M. Therapeutic options in non-alcoholic steatohepatitis
    (NASH). Are all agents alike? Results of a preliminary study. J Gastrointestin Liver Dis. Mar 2007;16(1):39-46. [Medline].
  • Harrison SA, Neuschwander-Tetri BA. Pharmacologic management of nonalcoholic fatty liver disease. Clin Liver Dis. Aug 2004;8(3):715-28, xii. [Medline].
  • Khashab M, Chalasani N. Use of Insulin Sensitizers in NASH. Endocrinology and Metobolism Clinics. 2007;36.
  • Ong JP, Younossi ZM. Approach to the diagnosis and treatment of nonalcoholic fatty liver disease. Clin Liver Dis. Nov 2005;9(4):617-34, vi. [Medline].
  • Kadyifci, Merriman, Bass. Medical Treatment of NASH. Clinics in Liver Disease. Feb 2007;11.
  • Adams LA, Zein CO, Angulo P, et al. A pilot trial of pentoxifylline in nonalcoholic steatohepatitis. Am J Gastroenterol. Dec 2004;99(12):2365-8. [Medline].
  • Satapathy
    SK, Sakhuja P, Malhotra V, et al. Beneficial effects of pentoxifylline
    on hepatic steatosis, fibrosis and necroinflammation in patients with
    non-alcoholic steatohepatitis. J Gastroenterol Hepatol. May 2007;22(5):634-8. [Medline].
  • Vial
    P, Riquelme A, Pizarro M, et al. Pentoxifylline does not prevent
    neither liver damage nor early profibrogenic events in a rat model of
    non-alcoholic steatohepatitis. Ann Hepatol. Jan-Mar 2006;5(1):25-9.
  • Yalniz
    M, Bahcecioglu IH, Kuzu N, et al. Amelioration of steatohepatitis with
    pentoxifylline in a novel nonalcoholic steatohepatitis model induced by
    high-fat diet. Dig Dis Sci. Sep 2007;52(9):2380-6. [Medline].
  • Hussein
    O, Grosovski M, Schlesinger S, et al. Orlistat reverse fatty
    infiltration and improves hepatic fibrosis in obese patients with
    nonalcoholic steatohepatitis (NASH). Dig Dis Sci. Oct 2007;52(10):2512-9. [Medline].
  • Charatcharoenwitthaya
    P, Levy C, Angulo P, et al. Open-label pilot study of folic acid in
    patients with nonalcoholic steatohepatitis. Liver Int. Mar 2007;27(2):220-6. [Medline].
  • Hirose
    A, Ono M, Saibara T, et al. Angiotensin II type 1 receptor blocker
    inhibits fibrosis in rat nonalcoholic steatohepatitis. Hepatology. Jun 2007;45(6):1375-81. [Medline].
  • Iba. Effect of losartan on early liver fibrosis development in a rat model of NASH. J Gastroenterol Hepatol. Jun 2007;22:846-51.
  • Zamora-Valdaos. Experimental evidence of OSA syndromes as a second hit accomplice in NASH pathogenesis. Ann Hepatol. Oct 2007;6:281-3.
  • Jouet,
    Sabate, Maillard, et al. Relationship between OSA and liver
    abnormalities in morbidly obese patients: A prospective Study. Obes Surg. 2007;17:478-485.
  • Savransky
    V, Bevans S, Nanayakkara A, et al. Chronic intermittent hypoxia causes
    hepatitis in a mouse model of diet-induced fatty liver. Am J Physiol Gastrointest Liver Physiol. Oct 2007;293(4):G871-7. [Medline].
  • Mendez-Sanchez, Zamor-Valdes, Richardo-Bahena, et al. Endocannabiod receptor CB2 in NAFLD. Liver International. 2006;215-19.
  • Thong-Ngam. N-acetylecysteine attenuates oxidative stress and liver pathology in rats with NASH. World J Gastroenterol. Oct 2007;13:5127-32.
  • Samuhasaneeto
    S, Thong-Ngam D, Kulaputana O, et al. Effects of N-acetylcysteine on
    oxidative stress in rats with non-alcoholic steatohepatitis. J Med Assoc Thai. Apr 2007;90(4):788-97. [Medline].
  • Dixon John. Surgical Treatment for Obesity and Its impact on NASH. Clinics in Liver Disease. Feb 2007;11.
  • Furuya
    CK Jr, de Oliveira CP, de Mello ES, et al. Effects of bariatric surgery
    on nonalcoholic fatty liver disease: preliminary findings after 2
    years. J Gastroenterol Hepatol. Apr 2007;22(4):510-4. [Medline].
  • Liu, Lazenby, Clements, et al. Resolution of NASH after Gastric Bypass Surgery. Obesity Surgery. 2007;17:486-92.
  • Jaskiewicz K, Raczynska S, Rzepko R, et al. Nonalcoholic fatty liver disease treated by gastroplasty. Dig Dis Sci. Jan 2006;51(1):21-6. [Medline].
  • Barker KB, Palekar NA, Bowers SP, et al. Non-alcoholic steatohepatitis: effect of Roux-en-Y gastric bypass surgery. Am J Gastroenterol. Feb 2006;101(2):368-73. [Medline].
  • Foster
    T, Budoff MJ, Saab S, Ahmadi N, Gordon C, Guerci AD. Atorvastatin and
    antioxidants for the treatment of nonalcoholic fatty liver disease: the
    St Francis Heart Study randomized clinical trial. Am J Gastroenterol. Jan 2011;106(1):71-7. [Medline].
  • Powell
    EE, Cooksley WG, Hanson R, et al. The natural history of nonalcoholic
    steatohepatitis: a follow-up study of forty-two patients for up to 21
    years. Hepatology. Jan 1990;11(1):74-80. [Medline].
  • Hui JM, Kench JG, Chitturi S, et al. Long-term outcomes of cirrhosis in nonalcoholic steatohepatitis compared with hepatitis C. Hepatology. Aug 2003;38(2):420-7. [Medline].
  • [Best
    Evidence] Adams LA, Lymp JF, St Sauver J, et al. The natural history of
    nonalcoholic fatty liver disease: a population-based cohort study. Gastroenterology. Jul 2005;129(1):113-21. [Medline].
  • Dam-Larsen S, Franzmann M, Andersen IB, et al. Long term prognosis of fatty liver: risk of chronic liver disease and death. Gut. May 2004;53(5):750-5. [Medline].
  • Hashizum. Primary liver cancers with NASH. Eur J Gastoenterol Hepatol. Oct 2007;19:827-34.
  • 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. Jan 2005;42(1):132-8. [Medline].
  • Haukeland
    JW, Konopski Z, Linnestad P, et al. Abnormal glucose tolerance is a
    predictor of steatohepatitis and fibrosis in patients with non-alcoholic
    fatty liver disease. Scand J Gastroenterol. Dec 2005;40(12):1469-77. [Medline].
  • Abdelmalek M, Diehl A. NAFLD as a complication of Insulin Resistance. Med Clinics of NA. 2007;91.
  • Adams
    LA, Angulo P, Abraham SC, et al. The effect of the metabolic syndrome,
    hepatic steatosis and steatohepatitis on liver fibrosis in hereditary
    hemochromatosis. Liver Int. Apr 2006;26(3):298-304. [Medline].
  • Bacon BR, Farahvash MJ, Janney CG, et al. Nonalcoholic steatohepatitis: an expanded clinical entity. Gastroenterology. Oct 1994;107(4):1103-9. [Medline].
  • Diehl AM. Nonalcoholic steatohepatitis. Semin Liver Dis. 1999;19(2):221-9. [Medline].
  • Edmison J, McCullough. Pathogenesis of NASH: Human Data. Clinics in Liver Disease. February 2007;11.
  • Liang.
    Diagnostic values of ultrasonographic examination for NASH in morbidly
    obese patients underoging laparoscopic bariatric surgery. Obes Surg. Jan 2007;17:45-56.
  • Yoneda
    M, Fujita K, Nozaki Y, Endo H, Takahashi H, Hosono K, et al. Efficacy
    of ezetimibe for the treatment of non-alcoholic steatohepatitis: An
    open-label, pilot study. Hepatol Res. Jun 2010;40(6):613-21. [Medline].
  • Kistler
    KD, Brunt EM, Clark JM, Diehl AM, Sallis JF, Schwimmer JB. Physical
    activity recommendations, exercise intensity, and histological severity
    of nonalcoholic Fatty liver disease. Am J Gastroenterol. Mar 2011;106(3):460-8. [Medline].
  • Johnson
    NA, Sachinwalla T, Walton DW, Smith K, Armstrong A, Thompson MW, et al.
    Aerobic exercise training reduces hepatic and visceral lipids in obese
    individuals without weight loss. Hepatology. Oct 2009;50(4):1105-12. [Medline].
  • Botezelli
    JD, Mora RF, Dalia RA, Moura LP, Cambri LT, Ghezzi AC, et al. Exercise
    counteracts fatty liver disease in rats fed on fructose-rich diet. Lipids Health Dis. Oct 14 2010;9:116. [Medline]. [Full Text].
  • Promrat
    K, Kleiner DE, Niemeier HM, Jackvony E, Kearns M, Wands JR. Randomized
    controlled trial testing the effects of weight loss on nonalcoholic
    steatohepatitis. Hepatology. Jan 2010;51(1):121-9. [Medline].
  • Kohli
    R, Kirby M, Xanthakos SA, Softic S, Feldstein AE, Saxena V.
    High-fructose, medium chain trans fat diet induces liver fibrosis and
    elevates plasma coenzyme Q9 in a novel murine model of obesity and
    nonalcoholic steatohepatitis. Hepatology. Sep 2010;52(3):934-44. [Medline].
  • Sanyal
    AJ, Chalasani N, Kowdley KV, McCullough A, Diehl AM, Bass NM.
    Pioglitazone, vitamin E, or placebo for nonalcoholic steatohepatitis. N Engl J Med. May 6 2010;362(18):1675-85. [Medline].
  • Foster
    T, Budoff MJ, Saab S, Ahmadi N, Gordon C, Guerci AD. Atorvastatin and
    antioxidants for the treatment of nonalcoholic fatty liver disease: the
    St Francis Heart Study randomized clinical trial. Am J Gastroenterol. Jan 2011;106(1):71-7. [Medline].

Back to top Go down
View user profile

Fatty Liver

View previous topic View next topic Back to top 
Page 1 of 1

Permissions in this forum:You cannot reply to topics in this forum
Medical Book :: General Medical Articles & Journal :: Internal Medicine Articles-