The emergence of non-alcoholic fatty liver disease (NAFLD) as the leading chronic liver disease worldwide raises some concerns. In particular, NAFLD is closely tied to sedentary lifestyle habits and ...associated with other metabolic diseases, such as obesity and diabetes. At the end of the disease spectrum, non-alcoholic steatohepatitis (NASH) may progress to cirrhosis and hepatocellular carcinoma (HCC), representing a serious health problem to modern society. Recently, an increasing number of HCC cases originating from this progressive disease spectrum have been identified, with different levels of severity and complications. Updating the current guidelines by placing a bigger focus on this emerging cause and highlighting some of its unique features is necessary. Since, the drivers of the disease are complex and multifactorial, in order to improve future outcomes, having a better understanding of NASH progression into HCC may be helpful. The risks that can promote disease progression and currently available management strategies employed to monitor and treat NASH-related HCC make up the bulk of this review.
The newly proposed term "metabolic dysfunction-associated fatty liver disease" (MAFLD) is replacing the old term "non-alcoholic fatty liver disease" (NAFLD) in many global regions, because it better ...reflects the pathophysiology and cardiometabolic implications of this common liver disease. The proposed change in terminology from NAFLD to MAFLD is not simply a single-letter change in an acronym, since MAFLD is defined by a set of specific and positive diagnostic criteria. In particular, the MAFLD definition specifically incorporates within the classification recognized cardiovascular risk factors. Although convincing evidence supports a significant association between both NAFLD and MAFLD, with increased risk of CVD morbidity and mortality, neither NAFLD nor MAFLD have received sufficient attention from the Cardiology community. In fact, there is a paucity of scientific guidelines focusing on this common and burdensome liver disease from cardiovascular professional societies. This Perspective article discusses the rationale and clinical relevance for Cardiologists of the newly proposed MAFLD definition.
Tobacco smoking is positively correlated with non-alcoholic fatty liver disease (NAFLD)
, but the underlying mechanism for this association is unclear. Here we report that nicotine accumulates in the ...intestine during tobacco smoking and activates intestinal AMPKα. We identify the gut bacterium Bacteroides xylanisolvens as an effective nicotine degrader. Colonization of B. xylanisolvens reduces intestinal nicotine concentrations in nicotine-exposed mice, and it improves nicotine-exacerbated NAFLD progression. Mechanistically, AMPKα promotes the phosphorylation of sphingomyelin phosphodiesterase 3 (SMPD3), stabilizing the latter and therefore increasing intestinal ceramide formation, which contributes to NAFLD progression to non-alcoholic steatohepatitis (NASH). Our results establish a role for intestinal nicotine accumulation in NAFLD progression and reveal an endogenous bacterium in the human intestine with the ability to metabolize nicotine. These findings suggest a possible route to reduce tobacco smoking-exacerbated NAFLD progression.
Background & Aims
Patatin‐like phospholipase domain‐containing protein 3 (PNPLA3) rs738409 polymorphism is associated with NAFLD severity and the PNPLA3 gene is expressed in the kidneys, but whether ...PNPLA3 rs738409 polymorphism is also associated with renal tubular injury (RTI) is uncertain. We assessed the effect of PNPLA3 genotypes on biomarkers of RTI and glomerular function in subjects with NAFLD who had either normal (nALT) or abnormal (abnALT) alanine aminotransaminase levels.
Methods
Two hundred and seventeen patients with histologically proven NAFLD of which 75 had persistently nALT (below upper limit of normal for 3 months) were included. Multivariable regression analyses were undertaken to test associations between PNPLA3 genotype and biomarkers of kidney dysfunction.
Results
The nALT patient group had higher urinary neutrophil gelatinase‐associated lipocalin levels (u‐NGAL, a biomarker of RTI) (P < .001), higher albuminuria (P = .039) and greater prevalence of chronic kidney disease (CKD; P = .046) than the abnALT group. The association between PNPLA3 GG genotype and risk of CKD and abnormal albuminuria remained significant after adjustment for kidney risk factors and severity of NAFLD histology, mostly in the nALT group. Similarly, PNPLA3 GG genotype was associated with higher u‐NGAL levels in the nALT group, even after adjustment for the aforementioned risk factors and glomerular filtration‐based markers (β‐coefficient: 22.29, 95% CI: 0.99‐43.60, P = .041).
Conclusion
Patients with NAFLD and persistently nALT, who carry the PNPLA3 rs738409 G allele, are at higher risk of early glomerular and tubular damage. We suggest PNPLA3 genotyping may help identify patients with NAFLD at higher risk of RTI.
LINKED CONTENT
This article is linked to Zhou et al and Wong papers. To view these articles, visit https://doi.org/10.1111/apt.16487 and https://doi.org/10.1111/apt.16507
LINKED CONTENT
This article is linked to Cheung et al papers. To view these articles, visit
https://doi.org/10.1111/apt.17722
and
https://doi.org/10.1111/apt.17744
Polarizing opinions have recently arisen in hepatology on the name and redefinition of fatty liver disease associated with metabolic dysfunction. In spite of growing and robust evidence of the ...superior utility of the term metabolic (dysfunction) associated fatty liver disease (MAFLD) definition for clinical and academic practice, controversy abounds. It should therefore come, as no surprise that the most common arguments used in contrarian op‐eds is that there are no consensus on any name change. In this context, we suggest that discourse on an accurate understanding of what scientific consensus means, the various methods of achieving consensus, as well as other alternative models for reaching agreement is pivotal for the field. In this opinion piece, we provide an overview of these aspects as it applies to the case of fatty liver disease. We provide evidence that consensus on a change from non‐alcoholic fatty liver disease (NAFLD) to MAFLD has already been achieved. We believe that the time has come for redirecting stakeholder focus and energy on capitalizing on the momentum generated by the debate to improve the lives of people at its centre, our patients.
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