Fatty liver disease: An updated overview of risk factors
Keywords:
Nonalcoholic fatty liver disease, NAFLD, obesity, type 2 diabetes, genetics, obstructive sleep apnea, gut microbiomeAbstract
Background: Nonalcoholic fatty liver disease (NAFLD) represents a growing global health concern, affecting approximately 25% of the population and serving as a precursor to severe liver conditions such as cirrhosis and hepatocellular carcinoma. The complexity of NAFLD is compounded by various risk factors, including obesity, diet, type 2 diabetes mellitus (T2DM), genetic predispositions, obstructive sleep apnea (OSA), and alterations in gut microbiota. Aim: This article aims to provide a comprehensive overview of the risk factors associated with the development and progression of NAFLD, emphasizing their interrelated roles. Methods: The literature was reviewed, focusing on epidemiological studies, cohort analyses, and meta-analyses that elucidate the connection between these risk factors and NAFLD. Key databases were searched for relevant publications, and data were synthesized to present a cohesive understanding of the current landscape of NAFLD research. Results: The findings underscore obesity and central obesity as significant contributors to NAFLD, with increased body mass index (BMI) and waist circumference directly correlating with the disease's prevalence. Dietary factors, particularly high fructose consumption, were linked to enhanced lipogenesis and mitochondrial dysfunction. Additionally, T2DM was identified as a substantial independent risk factor for hepatic fibrosis.
Downloads
References
Younossi ZM, Koenig AB, Abdelatif D, Fazel Y, Henry L, Wymer M. Global epidemiology of nonalcoholic fatty liver disease-Meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology. 2016;64:73–84. doi: 10.1002/hep.28431. DOI: https://doi.org/10.1002/hep.28431
Kim M, Yoon EL, Cho S, Lee CM, Kang BK, Park H, et al. Prevalence of advanced hepatic fibrosis and comorbidity in metabolic dysfunction-associated fatty liver disease in Korea. Liver Int. 2022;42:1536–1544. doi: 10.1111/liv.15259. DOI: https://doi.org/10.1111/liv.15259
Arrese M, Arab JP, Barrera F, Kaufmann B, Valenti L, Feldstein AE. Insights into nonalcoholic fatty-liver disease heterogeneity. Semin Liver Dis. 2021;41:421–434. doi: 10.1055/s-0041-1730927. DOI: https://doi.org/10.1055/s-0041-1730927
Estes C, Chan HLY, Chien RN, Chuang WL, Fung J, Goh GB, et al. Modelling NAFLD disease burden in four Asian regions-2019-2030. Aliment Pharmacol Ther. 2020;51:801–811. doi: 10.1111/apt.15673. DOI: https://doi.org/10.1111/apt.15673
Estes C, Razavi H, Loomba R, Younossi Z, Sanyal AJ. Modeling the epidemic of nonalcoholic fatty liver disease demonstrates an exponential increase in burden of disease. Hepatology. 2018;67:123–133. doi: 10.1002/hep.29466. DOI: https://doi.org/10.1002/hep.29466
Younossi Z, Tacke F, Arrese M, Chander Sharma B, Mostafa I, Bugianesi E, et al. Global perspectives on nonalcoholic fatty liver disease and nonalcoholic steatohepatitis. Hepatology. 2019;69:2672–2682. doi: 10.1002/hep.30251. DOI: https://doi.org/10.1002/hep.30251
Mantovani A, Csermely A, Petracca G, Beatrice G, Corey KE, Simon TG, et al. Non-alcoholic fatty liver disease and risk of fatal and non-fatal cardiovascular events: an updated systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2021;6:903–913. doi: 10.1016/S2468-1253(21)00308-3. DOI: https://doi.org/10.1016/S2468-1253(21)00308-3
Targher G, Byrne CD, Tilg H. NAFLD and increased risk of cardiovascular disease: clinical associations, pathophysiological mechanisms and pharmacological implications. Gut. 2020;69:1691–1705. doi: 10.1136/gutjnl-2020-320622. DOI: https://doi.org/10.1136/gutjnl-2020-320622
Allen AM, Hicks SB, Mara KC, Larson JJ, Therneau TM. The risk of incident extrahepatic cancers is higher in non-alcoholic fatty liver disease than obesity - A longitudinal cohort study. J Hepatol. 2019;71:1229–1236. doi: 10.1016/j.jhep.2019.08.018. DOI: https://doi.org/10.1016/j.jhep.2019.08.018
Simon TG, Roelstraete B, Khalili H, Hagström H, Ludvigsson JF. Mortality in biopsy-confirmed nonalcoholic fatty liver disease: results from a nationwide cohort. Gut. 2021;70:1375–1382. doi: 10.1136/gutjnl-2020-322786. DOI: https://doi.org/10.1136/gutjnl-2020-322786
Kim GA, Lee HC, Choe J, Kim MJ, Lee MJ, Chang HS, et al. Association between non-alcoholic fatty liver disease and cancer incidence rate. J Hepatol. 2017 Nov 2; doi: 10.1016/j.jhep.2017.09.012. doi: 10.1016/j.jhep.2017.09.012. DOI: https://doi.org/10.1016/j.jhep.2017.09.012
Mantovani A, Petracca G, Beatrice G, Csermely A, Tilg H, Byrne CD, et al. Non-alcoholic fatty liver disease and increased risk of incident extrahepatic cancers: a meta-analysis of observational cohort studies. Gut. 2022;71:778–788. doi: 10.1136/gutjnl-2021-324191 DOI: https://doi.org/10.1136/gutjnl-2021-324191
Younossi ZM, Corey KE, Alkhouri N, Noureddin M, Jacobson I, Lam B, et al. US Members of the Global Nash Council Clinical assessment for high-risk patients with non-alcoholic fatty liver disease in primary care and diabetology practices. Aliment Pharmacol Ther. 2020;52:513–526. doi: 10.1111/apt.15830. DOI: https://doi.org/10.1111/apt.15830
Simon TG, Roelstraete B, Hartjes K, Shah U, Khalili H, Arnell H, et al. Non-alcoholic fatty liver disease in children and young adults is associated with increased long-term mortality. J Hepatol. 2021;75:1034–1041. doi: 10.1016/j.jhep.2021.06.034. DOI: https://doi.org/10.1016/j.jhep.2021.06.034
Fracanzani AL, Petta S, Lombardi R, Pisano G, Russello M, Consonni D, et al. Liver and cardiovascular damage in patients with lean nonalcoholic fatty liver disease, and association with visceral obesity. Clin Gastroenterol Hepatol. 2017;15:1604–1611. doi: 10.1016/j.cgh.2017.04.045. e1. DOI: https://doi.org/10.1016/j.cgh.2017.04.045
Pang Q, Zhang JY, Song SD, Qu K, Xu XS, Liu SS, et al. Central obesity and nonalcoholic fatty liver disease risk after adjusting for body mass index. World J Gastroenterol. 2015;21:1650–1662. doi: 10.3748/wjg.v21.i5.1650. DOI: https://doi.org/10.3748/wjg.v21.i5.1650
Tsompanaki E, Thanapirom K, Papatheodoridi M, Parikh P, Chotai de Lima Y, Tsochatzis EA. Systematic review and metaanalysis: The role of diet in the development of nonalcoholic fatty liver disease. Clin Gastroenterol Hepatol. 2021 Nov 25; doi: 10.1016/j.cgh.2021.11.026. doi: 10.1016/j.cgh.2021.11.026. DOI: https://doi.org/10.1016/j.cgh.2021.11.026
Kwak JH, Jun DW, Lee SM, Cho YK, Lee KN, Lee HL, et al. Lifestyle predictors of obese and non-obese patients with nonalcoholic fatty liver disease: A cross-sectional study. Clin Nutr. 2018;37:1550–1557. doi: 10.1016/j.clnu.2017.08.018. DOI: https://doi.org/10.1016/j.clnu.2017.08.018
shimoto T, Lanaspa MA, Le MT, Garcia GE, Diggle CP, Maclean PS, et al. Opposing effects of fructokinase C and A isoforms on fructose-induced metabolic syndrome in mice. Proc Natl Acad Sci U S A. 2012;109:4320–4325. doi: 10.1073/pnas.1119908109. DOI: https://doi.org/10.1073/pnas.1119908109
Lanaspa MA, Sanchez-Lozada LG, Choi YJ, Cicerchi C, Kanbay M, Roncal-Jimenez CA, et al. Uric acid induces hepatic steatosis by generation of mitochondrial oxidative stress: Potential role in fructose-dependent and -independent fatty liver. J Biol Chem. 2012;287:40732–40744. doi: 10.1074/jbc.M112.399899. DOI: https://doi.org/10.1074/jbc.M112.399899
Rahman K, Desai C, Iyer SS, Thorn NE, Kumar P, Liu Y, et al. Loss of junctional adhesion molecule a promotes severe steatohepatitis in mice on a diet high in saturated fat, fructose, and cholesterol. Gastroenterology. 2016;151:733–746.e12. doi: 10.1053/j.gastro.2016.06.022. DOI: https://doi.org/10.1053/j.gastro.2016.06.022
Alferink LJ, Kiefte-de Jong JC, Erler NS, Veldt BJ, Schoufour JD, de Knegt RJ, et al. Association of dietary macronutrient composition and non-alcoholic fatty liver disease in an ageing population: The Rotterdam Study. Gut. 2019;68:1088–1098. doi: 10.1136/gutjnl-2017-315940. DOI: https://doi.org/10.1136/gutjnl-2017-315940
Younossi ZM, Golabi P, de Avila L, Paik JM, Srishord M, Fukui N, et al. The global epidemiology of NAFLD and NASH in patients with type 2 diabetes: A systematic review and meta-analysis. J Hepatol. 2019;71:793–801. doi: 10.1016/j.jhep.2019.06.021. DOI: https://doi.org/10.1016/j.jhep.2019.06.021
Nobili V, Mantovani A, Cianfarani S, Alisi A, Mosca A, Sartorelli MR, et al. Prevalence of prediabetes and diabetes in children and adolescents with biopsy-proven non-alcoholic fatty liver disease. J Hepatol. 2019;71:802–810. doi: 10.1016/j.jhep.2019.06.023. DOI: https://doi.org/10.1016/j.jhep.2019.06.023
Kang KA, Jun DW, Kim MS, Kwon HJ, Nguyen MH. Prevalence of significant hepatic fibrosis using magnetic resonance elastography in a health check-up clinic population. Aliment Pharmacol Ther. 2020;51:388–396. doi: 10.1111/apt.15626. DOI: https://doi.org/10.1111/apt.15626
Park H, Yoon EL, Cho S, Jun DW, Nah EH. Diabetes is the strongest risk factor of hepatic fibrosis in lean patients with nonalcoholic fatty liver disease. Gut. 2022;71:1035–1036. doi: 10.1136/gutjnl-2021-325102. DOI: https://doi.org/10.1136/gutjnl-2021-325102
Le P, Chaitoff A, Rothberg MB, McCullough A, Gupta NM, Alkhouri N. Population-based trends in prevalence of nonalcoholic fatty liver disease in US adults with type 2 diabetes. Clin Gastroenterol Hepatol. 2019;17:2377–2378. doi: 10.1016/j.cgh.2018.11.023. DOI: https://doi.org/10.1016/j.cgh.2018.11.023
Kwok R, Choi KC, Wong GL, Zhang Y, Chan HL, Luk AO, et al. Screening diabetic patients for non-alcoholic fatty liver disease with controlled attenuation parameter and liver stiffness measurements: a prospective cohort study. Gut. 2016;65:1359–1368. doi: 10.1136/gutjnl-2015-309265 DOI: https://doi.org/10.1136/gutjnl-2015-309265
Jun DW. An analysis of polygenic risk scores for non-alcoholic fatty liver disease. Clin Mol Hepatol. 2021;27:446–447. doi: 10.3350/cmh.2021.0133. DOI: https://doi.org/10.3350/cmh.2021.0133
Trépo E, Valenti L. Update on NAFLD genetics: From new variants to the clinic. J Hepatol. 2020;72:1196–1209. doi: 10.1016/j.jhep.2020.02.020. DOI: https://doi.org/10.1016/j.jhep.2020.02.020
Nobili V, Alisi A, Valenti L, Miele L, Feldstein AE, Alkhouri N. NAFLD in children: New genes, new diagnostic modalities and new drugs. Nat Rev Gastroenterol Hepatol. 2019;16:517–530. doi: 10.1038/s41575-019-0169-z DOI: https://doi.org/10.1038/s41575-019-0169-z
Ito T, Ishigami M, Zou B, Tanaka T, Takahashi H, Kurosaki M, et al. The epidemiology of NAFLD and lean NAFLD in Japan: A metaanalysis with individual and forecasting analysis, 1995-2040. Hepatol Int. 2021;15:366–379. doi: 10.1007/s12072-021-10143-4. DOI: https://doi.org/10.1007/s12072-021-10143-4
Unalp-Arida A, Ruhl CE. Patatin-like phospholipase domain-containing protein 3 I148M and liver fat and fibrosis scores predict liver disease mortality in the U.S. population. Hepatology. 2020;71:820–834. doi: 10.1002/hep.31032 DOI: https://doi.org/10.1002/hep.31032
Umbro I, Fabiani V, Fabiani M, Angelico F, Del Ben M. Association between non-alcoholic fatty liver disease and obstructive sleep apnea. World J Gastroenterol. 2020;26:2669–2681. doi: 10.3748/wjg.v26.i20.2669. DOI: https://doi.org/10.3748/wjg.v26.i20.2669
Musso G, Cassader M, Olivetti C, Rosina F, Carbone G, Gambino R. Association of obstructive sleep apnoea with the presence and severity of non-alcoholic fatty liver disease. A systematic review and meta-analysis. Obes Rev. 2013;14:417–431. doi: 10.1111/obr.12020 DOI: https://doi.org/10.1111/obr.12020
Savransky V, Nanayakkara A, Vivero A, Li J, Bevans S, Smith PL, et al. Chronic intermittent hypoxia predisposes to liver injury. Hepatology. 2007;45:1007–1013. doi: 10.1002/hep.21593. DOI: https://doi.org/10.1002/hep.21593
Albillos A, de Gottardi A, Rescigno M. The gut-liver axis in liver disease: Pathophysiological basis for therapy. J Hepatol. 2020;72:558–577. doi: 10.1016/j.jhep.2019.10.003. DOI: https://doi.org/10.1016/j.jhep.2019.10.003
Kolodziejczyk AA, Zheng D, Shibolet O, Elinav E. The role of the microbiome in NAFLD and NASH. EMBO Mol Med. 2019;11:e9302. doi: 10.15252/emmm.201809302. DOI: https://doi.org/10.15252/emmm.201809302
Martinez-Guryn K, Hubert N, Frazier K, Urlass S, Musch MW, Ojeda P, et al. Small intestine microbiota regulate host digestive and absorptive adaptive responses to dietary lipids. Cell Host Microbe. 2018;23:458–469. doi: 10.1016/j.chom.2018.03.011. e5. DOI: https://doi.org/10.1016/j.chom.2018.03.011
Hong HC, Hwang SY, Choi HY, Yoo HJ, Seo JA, Kim SG, et al. Relationship between sarcopenia and nonalcoholic fatty liver disease: The Korean Sarcopenic Obesity Study. Hepatology. 2014;59:1772–1778. doi: 10.1002/hep.26716. DOI: https://doi.org/10.1002/hep.26716
Lee YH, Kim SU, Song K, Park JY, Kim DY, Ahn SH, et al. Sarcopenia is associated with significant liver fibrosis independently of obesity and insulin resistance in nonalcoholic fatty liver disease: Nationwide surveys (KNHANES 2008-2011) Hepatology. 2016;63:776–786. doi: 10.1002/hep.28376. DOI: https://doi.org/10.1002/hep.28376
Koo BK, Kim D, Joo SK, Kim JH, Chang MS, Kim BG, et al. Sarcopenia is an independent risk factor for non-alcoholic steatohepatitis and significant fibrosis. J Hepatol. 2017;66:123–131. doi: 10.1016/j.jhep.2016.08.019. DOI: https://doi.org/10.1016/j.jhep.2016.08.019
Moon JH, Koo BK, Kim W. Non-alcoholic fatty liver disease and sarcopenia additively increase mortality: a Korean nationwide survey. J Cachexia Sarcopenia Muscle. 2021;12:964–972. doi: 10.1002/jcsm.12719. DOI: https://doi.org/10.1002/jcsm.12719
Zambon Azevedo V, Silaghi CA, Maurel T, Silaghi H, Ratziu V, Pais R. Impact of sarcopenia on the severity of the liver damage in patients with non-alcoholic fatty liver disease. Front Nutr. 2022;8:774030. doi: 10.3389/fnut.2021.774030. DOI: https://doi.org/10.3389/fnut.2021.774030
Zeng X, Shi ZW, Yu JJ, Wang LF, Luo YY, Jin SM, et al. Sarcopenia as a prognostic predictor of liver cirrhosis: a multicentre study in China. J Cachexia Sarcopenia Muscle. 2021;12:1948–1958. doi: 10.1002/jcsm.12797. DOI: https://doi.org/10.1002/jcsm.12797
Merz KE, Thurmond DC. Role of skeletal muscle in insulin resistance and glucose uptake. Compr Physiol. 2020;10:785–809. doi: 10.1002/cphy.c190029. DOI: https://doi.org/10.1002/cphy.c190029
Li CW, Yu K, Shyh-Chang N, Jiang Z, Liu T, Ma S, et al. Pathogenesis of sarcopenia and the relationship with fat mass: descriptive review. J Cachexia Sarcopenia Muscle. 2022;13:781–794. doi: 10.1002/jcsm.12901 DOI: https://doi.org/10.1002/jcsm.12901
Cotter TG, Rinella M. Nonalcoholic fatty liver disease 2020: the state of the disease. Gastroenterology. 2020;158:1851–1864. doi: 10.1053/j.gastro.2020.01.052. DOI: https://doi.org/10.1053/j.gastro.2020.01.052
Powell EE, Wong VW, Rinella M. Non-alcoholic fatty liver disease. Lancet. 2021;397:2212–2224. doi: 10.1016/S0140-6736(20)32511-3. DOI: https://doi.org/10.1016/S0140-6736(20)32511-3
Tantai X, Liu Y, Yeo YH, Praktiknjo M, Mauro E, Hamaguchi Y, et al. Effect of sarcopenia on survival in patients with cirrhosis: A meta-analysis. J Hepatol. 2022;76:588–599. doi: 10.1016/j.jhep.2021.11.006. DOI: https://doi.org/10.1016/j.jhep.2021.11.006
Published
How to Cite
Issue
Section
Copyright (c) 2023 International journal of health sciences
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Articles published in the International Journal of Health Sciences (IJHS) are available under Creative Commons Attribution Non-Commercial No Derivatives Licence (CC BY-NC-ND 4.0). Authors retain copyright in their work and grant IJHS right of first publication under CC BY-NC-ND 4.0. Users have the right to read, download, copy, distribute, print, search, or link to the full texts of articles in this journal, and to use them for any other lawful purpose.
Articles published in IJHS can be copied, communicated and shared in their published form for non-commercial purposes provided full attribution is given to the author and the journal. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.
This copyright notice applies to articles published in IJHS volumes 4 onwards. Please read about the copyright notices for previous volumes under Journal History.