Best Practice & Research Clinical Gastroenterology
5Non-alcoholic fatty liver disease/non-alcoholic steatohepatitis (NAFLD/NASH): diagnosis and clinical course
Section snippets
When to suspect NAFLD/NASH?
These conditions should be suspected in individuals with persistent unexplained elevation of serum ALT. They should also be considered in the presence of risk factors such as obesity, diabetes and hyperlipidaemia. In the differential diagnosis of elevated aminotransferases, secondary forms of NAFLD should be hypothesized in individuals who are receiving drugs or have clinical conditions known to be associated with hepatic steatosis with or without necroinflammation.9., 10.
Patient demographics
Table 1 summarizes
Clinical course
Few studies address long-term follow-up, thus NAFLD/NASH natural history is difficult to ascertain. Progression seems mostly dependent on the severity of histological damage.9 Within the spectrum of NAFLD/NASH, patients with pure steatosis seem to have the best prognosis, when followed up to 19 years only 1/12 patients showed progression of fibrosis5, although another study in 49 patients with fatty liver alone reported 2 (4%) who progressed to cirrhosis.22 A more recent Danish study revealed
Summary
The true prevalence of NAFLD/NASH has been underestimated; it is likely to become more frequent worldwide, given the increasing diagnosis of major insulin resistant associated metabolic disorders: type 2 diabetes/overweight/obesity. There still is a widespread dismissal of the potential importance of the diagnosis which is mostly occasional, suspected because of elevated aminotransferases, typically ALT>AST, and/or bright liver on ultrasound, during a routine work-up. NAFLD/NASH tends to be
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2016, Cahiers de Nutrition et de DietetiqueCirculating adiponectin levels in type 2 diabetes mellitus patients with or without non-alcoholic fatty liver disease: Results of a small, open-label, randomized controlled intervention trial in a subgroup receiving short-term exenatide
2016, Diabetes Research and Clinical PracticeCitation Excerpt :The majority of patients with abnormal aminotransferases refused liver biopsy, and this remains within the limitations of our study. Even though normal aminotransferase level cannot exclude presence of NAFLD, however NASH has been repeatedly associated with abnormal ALT [37–39]. Statistical comparison of this group of patients with DMT2 patients with normal aminotransferases revealed that they did not differ in any of their baseline characteristics (gender, age, somatometrics, factors of insulin resistance, duration of diabetes, glucose control, CRP) other than their circulating adiponectin levels.
Evaluation of nonalcoholic fatty liver disease using magnetic resonance in obese children and adolescents
2019, Jornal de PediatriaCitation Excerpt :Nuclear magnetic resonance (NMR) is the most sensitive and objective imaging exam for the detection and quantitation of HS in adults, including levels much lower than normal reference values, whose cut-off point is ≤9%.5 NMR differentiates focal HS from possible malignant lesions,6 evaluates the distribution of body adiposity, does not emit ionizing radiation, and is not operator-dependent.7 The prevalence of NAFLD among obese children and adolescents varies when diagnosed by a liver biopsy, NMR, ultrasound (US), or changes in transaminases, with respective percentages of 13–58.1%, 31.8–40%, 13.7–75%, and 14–55.8% having been found.1
Triterpenoid-rich fraction from ilex hainanensis merr. attenuates non-alcoholic fatty liver disease induced by high fat diet in rats
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