Nonalcoholic fatty liver in Asia: Firmly entrenched and rapidly gaining ground

Date

2011

Authors

Chitturi, Shivakumar
Wong, Vincent
Farrell, Geoffrey

Journal Title

Journal ISSN

Volume Title

Publisher

Blackwell Publishing Ltd

Abstract

Nonalcoholic fatty liver disease (NAFLD) is becoming an important chronic liver disorder in Asia. Prevalence figures show regional variations but at least 10% of the general population in Asia have fatty liver. Fatty liver can develop with relatively small changes in weight (2-3 kg), often with increasing central adiposity. The metabolic syndrome may precede or follow NAFLD. Overt diabetes is present in one-third of cases but when oral glucose tolerance tests are performed, a further third of individuals have impaired glucose tolerance or diabetes. Natural history data are still scarce but cases of advanced hepatic fibrosis and hepatocellular carcinoma are now regularly reported. Many cases of cryptogenic cirrhosis are also attributable to NAFLD. Histological progression has been demonstrated for patients with NASH as well as for those with hepatic steatosis alone. Genetic factors may in part contribute to the rise in NAFLD. Polymorphisms within apolipoprotein C3 (APOC3) gene have been linked to NAFLD in lean Indian men. Although a number of other polymorphisms involving genes controlling adipose distribution, insulin signalling, adipokine responses and hepatic fibrosis have been reported, these studies have been underpowered. Transient elastography could help in detecting and monitoring hepatic fibrosis but further refinements in technique are necessary for obese individuals. Of the biomarkers, hyaluronic acid and cytokeratin-18 fragment testing show promise as markers of hepatic fibrosis and NASH, respectively. Lifestyle alterations including dietary changes and increased physical activity remain the cornerstone of management. Attention should be paid to prevention through public education of campaigns addressing the increase in both adult and childhood obesity.

Description

Keywords

Keywords: adipocytokine receptor; apolipoprotein C3; cytokeratin 18; glucose; hyaluronic acid; anthropometry; Asia; body mass; body weight; childhood disease; diabetes mellitus; diet therapy; disease course; disease severity; DNA polymorphism; elastography; exercis Cirrhosis; Fatty liver; Metabolic syndrome; NALFD; NASH; Steatohepatitis; Steatosis

Citation

Source

Journal of Gastroenterology and Hepatology

Type

Journal article

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Restricted until

2037-12-31