10 WORLD GASTROENTEROLOGY NEWS JANUARY 2016 Gastro 2015: AGW-WGO | Expert Point of View | Gastro 2016: EGHS-WGO | WDHD News | WGO & WGOF News | WGO Global Guidelines | Calendar of Events Nonalcoholic Fatty Liver Disease – A Growing Public Health Problem Davor Stimac, MD, PhD Department of Gastroenterology Head of Division for Internal Medicine UHC Rijeka Rijeka, Croatia Twenty five years ago, researchers were skeptical of whether nonalco-holic fatty liver disease (NAFLD) was actually a clinical condition. Along with tremendous progress in antiviral agents and treatment strategies, a vigorous national vaccination program for hepatitis B has resulted in a gradu-ally decreasing prevalence of end-stage liver disease caused by chronic viral hepatitis. Despite this, with the increasing prevalence of obesity, type II diabetes mellitus (T2DM), insulin resistance and hypertension, NAFLD has become the most common cause of chronic liver disease (CLD) and increasing socioeconomic cost for managing CLD in many developed countries worldwide. NAFLD also has reached epidemic proportions among populations typically considered at low risk, with a prevalence of 15% in China and 14% in Japan. NAFLD is strongly associated with all compo-nents of metabolic syndrome (MS) and has been considered as the liver manifestation of the MS. This entity encompasses simple liver steatosis, necroinflammation with varying stages of fibrosis known as nonalco-holic steatohepatitis (NASH), and cirrhosis. Compared with the general population NAFLD increases the risk of endstage liver disease, hepatocel-lular carcinoma (HCC), as well as liver-related and all-cause mortality.1-8 A subset of patients with NAFLD have the progressive form of liver dis-ease i.e. NASH which can lead to the development of cirrhosis and its com-plications, including HCC, especially if metabolic risk factors deteriorate.5, 6, 9,10 According to the recent review published in JAMA, 66% of patients older than 50 years with T2DM or obesity are thought to have NASH with advanced fibrosis.2 The incidence of NAFLD–related HCC is increasing and up to 50% of cases may occur in the absence of cirrhosis.2, 3 Moreover, recent findings imply that, contrary to current dogma, simple steatosis can progress to NASH and clinically significant fibrosis there-fore the majority of NAFLD patients are at risk of progressive liver disease in the longer term.11 Based on data from the USA adult liver transplantation (LTs) databases, since 2004 the number of adults with NASH awaiting LTs has almost tripled and today NASH is the second leading etiology of CLD among adults awaiting LTs in the USA.7 Because of the epidemic of NAFLD, NASH related cirrhosis is anticipated to become the leading indication for LTs within the next one or two decades.8 During the last decade, it has been shown that the global health burden of NAFLD is confined not only to potentially progressive liver disease, but there is now growing evidence that NAFLD is a multisystem disease, affecting several extra-hepatic organs. For example, NAFLD increases risk of T2DM, cardiovascular and cardiac diseases, and chronic kidney dis-ease. NAFLD is associated with an increased risk of developing ischemic heart disease, abnormalities of myo-cardial function and structure, and cardiac arrhythmias (e.g., atrial fibril-lation). Also, there is emerging evi-dence that NAFLD is linked to other chronic diseases, such as sleep apnea, adenomatous polyps of the colon and colorectal cancer, osteoporosis, polycystic ovary syndrome, psoriasis, and various endocrinopathies. Thus, NAFLD has become a growing public health problem.3, 9 Regarding the fact that most of MS components may be either prevent-able or improved through lifestyle changes or drug treatments, a ques-tion arises: “can NAFLD, and con-sequently NAFLD-related complica-tions be prevented in some way?”3, 6, 9 Nowadays there is no effective therapy for all NAFLD patients in general population. Most of the studies are Ivana Mikolasevic, MD, PhD Department of Gastroenterology UHC Rijeka Rijeka, Croatia
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