Almost one in three adults in industrialized countries suffer from non-alcoholic fatty liver. For the affected people this increases the risk of complications such as liver cirrhosis, liver cancer, type 2 diabetes, high blood pressure, heart attack and stroke. In a review article in 'The Lancet Diabetes & Endocrinology', Norbert Stefan and Hans-Ulrich Häring from the University of Tübingen and the DZD and Kenneth Cusi from the University of Florida summarize current research findings and show how this knowledge can be used for personalized risk prognosis and individualized treatment in the future.
More and more adults – but also about 34 percent of obese children – suffer from non-alcoholic fatty liver disease (NAFLD). An unhealthy lifestyle with little physical activity and a diet high in fat, sugar and fructose and/or a genetic predisposition can be the underlying caus. However, fatty liver includes a broad spectrum of liver conditions and involves more than just the liver itself. NAFLD is a complex and heterogeneous disease that can lead to various complications such as severe liver damage, type 2 diabetes and cardiovascular disease.
"In order to avoid these secondary diseases, fatty liver must be diagnosed in good time, and the respective risk for diseases of the liver, the heart and other organs must be precisely assessed. Then a personalized prevention and treatment can be developed," said first author Norbert Stefan. In recent years there have been many new findings and results in NAFLD research.
It is difficult to integrate this enormous amount of new data from basic research and clinical hepatology and endocrinology research into clinical practice. Professor Norbert Stefan and Professor Hans-Ulrich Häring – both from Tübingen University Hospital and the Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Zentrum München, a partner of the DZD, together with Professor Kenneth Cusi from the University of Florida (USA) have evaluated the most important data of NAFLD research and compiled them in a review article. The authors propose the use of new diagnostic and therapeutic approaches in the clinic to enable a specific risk prognosis for possible secondary diseases.
"Not only patients with elevated liver enzymes should be examined for fatty liver, but also people with a disproportionate fat distribution, i.e. a high proportion of abdominal fat and/or a low proportion of fat around the hips and legs," said Hans-Ulrich Häring. In addition, the authors of the review recommend fatty liver screening also for people suffering from insulin resistance or type 2 diabetes.
But how can the fat content in the liver be accurately determined and how can liver damage such as inflammation and fibrosis be reliably detected? The use of simple indices or ultrasound examinations is suitable for this in primary care. Specialists such as hepatologists, endocrinologists and radiologists could perform further examinations such as special magnetic resonance imaging (MRI) if required.
If patients suffer from fatty liver, positive effects can often be achieved with lifestyle intervention. For example, a reduction of about five percent in weight can reduce the fat content in the liver by up to 30 percent. However, to reduce the risk of liver inflammation and fibrosis, a weight loss of about ten percent is required.
"If such weight loss cannot be achieved or is insufficient to improve NAFLD, pharmacological treatment should be considered," said Cusi. To date, no drug has been approved for NAFLD. "However, under certain conditions such as diabetes and NAFLD or obesity and NAFLD, specific drugs can be used that have different effects on liver fat content, inflammation and fibrosis," Cusi went on to say.
Recent research suggests that genetic NAFLD is associated with a higher risk of liver fibrosis and liver cancer. “However, unexpectedly, the same patients have a low risk of cardiovascular diseases. In order to be able to treat those affected patients properly, it is important to know whether a fatty liver is genetically determined”, Stefan mentioned
The authors of the review believe that in the future, the application of these concepts will enable a personalized risk prognosis and individualized treatment of NAFLD. In addition, researchers will be able to specifically develop lifestyle modification programs and drugs for the respective subtypes based on the various aspects of this disease.
Media contact for inquiries about the current publication
Norbert Stefan, MD, PhD
Professor of Medicine
Heisenberg Professorship of clinical and experimental Diabetology
University of Tübingen
72076 Tübingen, Germany
Phone: +49 (0)7071 2980390
Kenneth Cusi, M.D., F.A.C.P., F.A.C.E.
Professor of Medicine
Chief, Division of Endocrinology, Diabetes and Metabolism
University of Florida
1600 SW Archer Rd; room H -2
Gainesville, FL 32610-0226
Norbert Stefan, Hans-Ulrich Häring, Kenneth Cusi. Non-alcoholic fatty liver disease: causes, cardiometabolic consequences, and treatment strategies. The Lancet Diabetes & Endocrinology 2018, DOI: 10.1016/S2213-8587(18)30154-2
Birgit Niesing | idw - Informationsdienst Wissenschaft
New 3D cultured cells mimic the progress of NASH
02.04.2020 | Tokyo University of Agriculture and Technology
Geneticists are bringing personal medicine closer to recently admixed individuals
02.04.2020 | Estonian Research Council
90 million-year-old forest soil provides unexpected evidence for exceptionally warm climate near the South Pole in the Cretaceous
An international team of researchers led by geoscientists from the Alfred Wegener Institute, Helmholtz Centre for Polar and Marine Research (AWI) have now...
The bacteria that cause tuberculosis need iron to survive. Researchers at the University of Zurich have now solved the first detailed structure of the transport protein responsible for the iron supply. When the iron transport into the bacteria is inhibited, the pathogen can no longer grow. This opens novel ways to develop targeted tuberculosis drugs.
One of the most devastating pathogens that lives inside human cells is Mycobacterium tuberculosis, the bacillus that causes tuberculosis. According to the...
An international team with the participation of Prof. Dr. Michael Kues from the Cluster of Excellence PhoenixD at Leibniz University Hannover has developed a new method for generating quantum-entangled photons in a spectral range of light that was previously inaccessible. The discovery can make the encryption of satellite-based communications much more secure in the future.
A 15-member research team from the UK, Germany and Japan has developed a new method for generating and detecting quantum-entangled photons at a wavelength of...
Together with their colleagues from the University of Würzburg, physicists from the group of Professor Alexander Szameit at the University of Rostock have devised a “funnel” for photons. Their discovery was recently published in the renowned journal Science and holds great promise for novel ultra-sensitive detectors as well as innovative applications in telecommunications and information processing.
The quantum-optical properties of light and its interaction with matter has fascinated the Rostock professor Alexander Szameit since College.
Researchers at the University of Zurich show that different stem cell populations are innervated in distinct ways. Innervation may therefore be crucial for proper tissue regeneration. They also demonstrate that cancer stem cells likewise establish contacts with nerves. Targeting tumour innervation could thus lead to new cancer therapies.
Stem cells can generate a variety of specific tissues and are increasingly used for clinical applications such as the replacement of bone or cartilage....
02.04.2020 | Event News
26.03.2020 | Event News
23.03.2020 | Event News
02.04.2020 | Physics and Astronomy
02.04.2020 | Information Technology
02.04.2020 | Health and Medicine