Mechanisms of nonalcoholic fatty liver disease and implications for surgery
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REVIEW ARTICLE
Mechanisms of nonalcoholic fatty liver disease and implications for surgery Benedikt Kaufmann 1,2 & Agustina Reca 1 & Baocai Wang 2 & Helmut Friess 2 & Ariel E. Feldstein 1 & Daniel Hartmann 2 Received: 29 July 2020 / Accepted: 9 August 2020 # The Author(s) 2020
Abstract Background Nonalcoholic fatty liver disease (NAFLD) has become the most common form of chronic liver disease in both adults and children worldwide. Understanding the pathogenic mechanisms behind NAFLD provides the basis for identifying risk factors, such as metabolic syndrome, pancreatoduodenectomy, and host genetics, that lead to the onset and progression of the disease. The progression from steatosis to more severe forms, such as steatohepatitis, fibrosis, and cirrhosis, leads to an increased number of liver and non-liver complications. Purpose NAFLD-associated end-stage liver disease (ESLD) and hepatocellular carcinoma (HCC) often require surgery as the only curative treatment. In particular, the presence of NAFLD together with the coexisting metabolic comorbidities that usually occur in these patients requires careful preoperative diagnosis and peri-/postoperative management. Bariatric surgery, liver resection, and liver transplantation (LT) have shown favorable results for weight loss, HCC, and ESLD in patients with NAFLD. The LT demand and the increasing spread of NAFLD in the donor pool reinforce the already existing lack of donor organs. Conclusion In this review, we will discuss the diverse mechanisms underlying NAFLD, its implications for surgery, and the challenges for patient management. Keywords NAFLD . Liver . Obesity
Introduction Nonalcoholic fatty liver disease (NAFLD) is the leading primary cause of chronic liver disease in both children and adults worldwide today. Global prevalence is estimated at 25% and accounts for the most common etiology of abnormal liver function tests in western countries [1]. NAFLD has reached epidemic proportions yet important geographic variabilities must be recognized. Its prevalence has been reported to be the highest in South America and the Middle East (> 30%), followed by Asia (27%) and North America and Europe, who have shown similar prevalence rates (24% and 23%,
Ariel E. Feldstein and Daniel Hartmann contributed equally to this work. * Daniel Hartmann [email protected] 1
Department of Pediatric Gastroenterology, University of California San Diego (UCSD), La Jolla, CA, USA
2
Department of Surgery, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany
respectively) [2]. Ethnicity also accounts for discrepancies within regions that may be explained by differences in lifestyle and diet, access to health care, and genetic factors. In the USA, Hispanic Americans have the highest prevalence of NAFLD and it has been shown that ethnic backgrounds influence individual susceptibility to the development of this disease [2]. NAFLD encompasses the entire spectrum of disease which are characterized by hepatic steatosis that develops i
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