Summary
The risk factors that are most strongly associated with nonalcoholic fatty liver disease (NAFLD) are: age greater than 40 to 50 years, and severe obesity, diabetes mellitus (DM), or hyperlipidemia (especially hypertriglyceridemia). The pathogenesis of nonalcoholic steatohepatitis (NASH) is multifactorial. Insulin resistance, fatty acids, and oxidant stress may be important pathogenic factors in NASH. Efforts are presently underway to define the role of these factors and to determine whether modifying them (for example, by improving insulin sensitivity) could be effective in the treatment of the condition. At present, lifestyle changes involving exercise and dietary restrictions appear to be an effective means of improving NASH. Physicians should actively check for the presence of NAFLD in those who are overweight and who have diabetes mellitus. The treatment is usually directed toward optimizing body weight. The role of pharmacological agents remains to be established, and much more work is necessary to define the pathogenesis of NASH and to develop effective treatments.
Access provided by Autonomous University of Puebla. Download to read the full chapter text
Chapter PDF
Similar content being viewed by others
Key words
References
Neuschwander-Tetri BA, Caldwell SH (2003) Nonalcoholic steatohepatitis: summary of an AASLD single topic conference. Hepatology 37: 1202–1219
Dixon JB, Bhathal PS, O’Brien PE (2001) Nonalcoholic fatty liver disease: predictors of nonalcoholic steatohepatitis and liver fibrosis in the severely obese. Gastroenterology 121: 91–100
Adler M, Schaffner F (1979) Fatty liver hepatitis and cirrhosis in obese patients. Am J Med 67: 811–816
Ito S, Tsukada Y, Motomura Y, Ichinoe A (1979) Five patients with nonalcoholic diabetic cirrhosis. Acta Hepatogastroenterol 26: 90–97
Ludwig J, Viggiano TR, McGill DB, Oh BJ (1980) Nonalcoholic steatohepatitis: Mayo Clinic experiences with a hitherto unnamed disease. Mayo Clin Proc 55: 434–438
Caldwell SH, Oelsner DH, Iezzoni JC, Hespenheide EE, Battle EH, Driscoll CJ (1999) Cryptogenic cirrhosis: clinical characterization and risk factors for underlying disease. Hepatology 29: 664–669
Struben VM, Hespenheide EE, Caldwell SH (2000) Nonalcoholic steatohepatitis and cryptogenic cirrhosis within kindreds. Am J Med 108: 9–13
Bugianesi E, Leone N, Vanni E, Marchesini G, Brunello F, Carucci P, Musso A, DePaolis P, Capussotti L, Salizzoni M, Rizzetto M (2002) Expanding the natural history of nonalcoholic steatohepatitis: from cryptogenic cirrhosis to hepatocellular carcinoma. Gastroenterology 123: 134–140
Shimada M, Hashimoto E, Taniai M, Hasegawa K, Okuda H, Hayashi N, Takasaki K, Ludwig J (2002) Hepatocellular carcinoma in patients with non-alcoholic steatohepatitis. J Hepatol 37: 154–160
Saltiel AR (2001) New perspectives into the molecular pathogenesis and treatment of type 2 diabetes. Cell 104: 517–529
Uysal KT, Wiesbrock SM, Marino MW, Hotamisligil GS (1997) Protection from obesityinduced insulin resistance in mice lacking TNF-α function. Nature 389: 610–614
Ikejima K, Takei Y, Honda H, Hirose M, Yoshikawa M, Zhang YJ, Lang T, Fukuda T, Yamashina S, Kitamura T, Sato N (2002) Leptin receptor-mediated signaling regulates hepatic fibrogenesis and remodeling of extracellularmatrix in the rat. Gastroenterology 122: 1399–1410
Saxena NK, Ikeda K, Rockey DC, Frieman SL, Anania FA (2002) Leptin in hepatic fibrosis: evidence for increased collagen production in stellate cells and lean littermates of ob/ob mice. Hepatology 35: 762–771
Chitturi S, Farrell G, Frost L, Kriketos A, Lin R, Fung C, Liddle C, Samarasinghe D, George J (2002) Serum leptin in NASH correlates with hepatic steatosis but not fibrosis: a manifestation of lipotoxicity? Hepatology 36: 403–409
Diehl AM, Goodman Z, Ishak KG (1988) Alcohol like liver disease in nonalcoholics. A clinical and histologic comparison with alcohol-induced liver injury. Gastroenterology 95: 1056–1062
Matteoni CA, Younossi ZM, Gramlich T, Boparai N, Liu YC, McCullough AJ (1999) Nonalcoholic fatty liver disease: a spectrum of clinical and pathological severity. Gastroenterology 116: 1413–1419
Basaranoglu M, Acbay O, Sonsuz A (1999) A controlled trial of gemfibrozil in the treatment of patients with nonalcoholic steatohepatitis. J Hepatol 31: 384
Marchesini G, Brizi M, Bianchi G, Tomassetti S, Zoli M, Melchionda N (2001) Metformin in non-alcoholic steatohepatitis. Lancet 358: 893–894
Arioglu E, Duncan-Morin J, Sebring N, Rother KI, Gottlieb N, Lieberman J, Herion D, Kleiner DE, Reynolds J, Premkumar A, Sumner AE, Hoofnagle J, Reitman ML, Taylor SI (2000) Efficacy and safety of troglitazone in the treatment of lipodystrophy syndromes. Ann Intern Med 133: 263–274
Caldwell SH, Hespenheide EE, Redick JA, Iezzoni JC, Battle EH, Sheppard BL (2001) A pilot study of a thiazolidinedione, troglitazone, in nonalcoholic steatohepatitis. Am J Gastroenterol 96: 519–525
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2005 Springer-Verlag Tokyo
About this paper
Cite this paper
Ueno, T., Nakamura, T., Sasaki, N., Morita, Y., Nagata, E., Sata, M. (2005). Pathogenesis and Significance of Restricted Diet and Exercise Therapy in Nonalcoholic Steatohepatitis (NASH). In: Okita, K. (eds) NASH and Nutritional Therapy. Springer, Tokyo. https://doi.org/10.1007/4-431-27172-4_7
Download citation
DOI: https://doi.org/10.1007/4-431-27172-4_7
Publisher Name: Springer, Tokyo
Print ISBN: 978-4-431-21388-8
Online ISBN: 978-4-431-27172-7
eBook Packages: MedicineMedicine (R0)