Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 21, 2016; 22(31): 7006-7016
Published online Aug 21, 2016. doi: 10.3748/wjg.v22.i31.7006
Metabolic aspects of adult patients with nonalcoholic fatty liver disease
Ludovico Abenavoli, Natasa Milic, Laura Di Renzo, Tomislav Preveden, Milica Medić-Stojanoska, Antonino De Lorenzo
Ludovico Abenavoli, Department of Health Sciences, University Magna Graecia, Campus Germaneto, Viale Europa, 88100 Catanzaro, Italy
Natasa Milic, Department of Pharmacy, Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia
Tomislav Preveden, Clinic for Infectious Diseases, Clinical Centre of Vojvodina, Faculty of Medicine, University of Novi Sad, 21101 Novi Sad, Serbia
Milica Medić-Stojanoska, Faculty of Medicine, Clinical Centre of Vojvodina, Clinic for Endocrinology, Diabetes and Metabolic Diseases, University of Novi Sad, 21000 Novi Sad, Serbia
Laura Di Renzo, Antonino De Lorenzo, Division of Clinical Nutrition and Nutrigenomic, Department of Biomedicine and Prevention, University of Tor Vergata, 00133 Rome, Italy
Author contributions: Abenavoli L designed the paper, performed the research of literature data and wrote the paper; Milic N and Preveden T acomplished the research of literature data and critically revised the paper; Di Renzo L helped to write the paper; Medić-Stojanoska M and De Lorenzo A analysed the data and drafted the article.
Conflict-of-interest statement: The authors confirm that this article content has no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Ludovico Abenavoli, MD, PhD, Department of Health Sciences, University Magna Graecia, Campus Germaneto, Viale Europa, 88100 Catanzaro, Italy.
Telephone: +39-961-3694387 Fax: +39-961-754220
Received: May 10, 2016
Peer-review started: May 11, 2016
First decision: May 30, 2016
Revised: June 7, 2016
Accepted: June 28, 2016
Article in press: June 28, 2016
Published online: August 21, 2016

Nonalcoholic fatty liver disease (NAFLD) is a major cause of chronic liver disease and it encompasses a spectrum from simple steatosis to steatohepatitis, fibrosis, or cirrhosis. The mechanisms involved in the occurrence of NAFLD and its progression are probably due to a metabolic profile expressed within the context of a genetic predisposition and is associated with a higher energy intake. The metabolic syndrome (MS) is a cluster of metabolic alterations associated with an increased risk for the development of cardiovascular diseases and diabetes. NAFLD patients have more than one feature of the MS, and now they are considered the hepatic components of the MS. Several scientific advances in understanding the association between NAFLD and MS have identified insulin resistance (IR) as the key aspect in the pathophysiology of both diseases. In the multi parallel hits theory of NAFLD pathogenesis, IR was described to be central in the predisposition of hepatocytes to be susceptible to other multiple pathogenetic factors. The recent knowledge gained from these advances can be applied clinically in the prevention and management of NAFLD and its associated metabolic changes. The present review analyses the current literature and highlights the new evidence on the metabolic aspects in the adult patients with NAFLD.

Keywords: Nonalcoholic fatty liver disease, Nonalcoholic steatohepatitis, Insulin resistance, Obesity, Metabolic syndrome

Core tip: In the recent years it has been reported that nonalcoholic fatty liver disease (NAFLD) pathogenesis is related with a multi hits theory where insulin resistance has a central role and renders hepatocytes susceptible to other pathogenetic factors including oxidative stress, dysregulation of cytokines production; increased intestinal permeability, intestinal dysbiosis, inflammation and fibrosis. In this context, numerous metabolic alterations are associated with NAFLD in the adult patients.