nonalcoholic%20fatty%20liver%20disease
NONALCOHOLIC FATTY LIVER DISEASE

Nonalcoholic fatty liver disease is having excessive hepatic fat (in the form of triglycerides) accumulation not due to excessive alcohol consumption or other secondary causes.

It is considered as a hepatic manifestation of metabolic syndrome.

Progression of nonalcoholic fatty liver disease is variable.

Introduction

  • Fatty liver is usually an incidental finding on abdominal imaging that reveals hepatic steatosis and laboratory study results of elevated liver enzymes
  • Considered as hepatic manifestation of metabolic syndrome (obesity, type 2 diabetes mellitus, insulin resistance, dyslipidemia and hypertension)
  • Most common liver disorder in the Western countries but less commonly reported in its general population
  • Becoming a serious health issue in many Asian countries
  • Prevalence is 2x higher in males than in females
  • Progression of nonalcoholic fatty liver disease (NAFLD) is variable; ranges from hepatic steatosis through inflammatory nonalcoholic steatohepatitis (NASH) to fibrosis or cirrhosis
  • Major cause of mortality in patients with NAFLD is cardiovascular disease

Definition

  • Excessive hepatic fat (in the form of triglycerides) accumulation not due to excessive alcohol consumption or other secondary causes

Signs and Symptoms

  • Patient usually presents asymptomatic but may describe vague right upper quadrant pain, fatigue and malaise

Risk Factors

  • Obesity
  • Insulin resistance/metabolic syndrome
  • High-calorie diet with saturated fats, refined carbohydrates, sugar-sweetened beverages and high fructose
  • Jejunoileal bypass surgery
  • Highest risk in 40-65 years old
  • Higher risk in Hispanics and Asians while lower risk in African-Americans
  • Genetic predisposition
  • Drugs and toxins (eg Amiodarone, Coralgil, corticosteroids, synthetic estrogens, Methotrexate, IV Tetracycline)
  • Polycystic ovary syndrome 
  • Hypothyroidism
  • Obstructive sleep apnea 
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