Nonalcoholic fatty liver disease in adults: current concepts in etiology, outcomes, and management

Marjot, Thomas; Moolla, Ahmad; Cobbold, Jeremy F; Hodson, Leanne; Tomlinson, Jeremy W

doi:10.1210/endrev/bnz009

Cited by 228Liver Disease Diagnosis and TreatmentAlcohol Consumption and Health EffectsLiver Diseases and Immunity

Nonalcoholic fatty liver disease in adults: current concepts in etiology, outcomes, and management

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Marjot, Thomas, Moolla, Ahmad, Cobbold, Jeremy F, Hodson, Leanne, Tomlinson, Jeremy W·2020·Endocrine Reviews

DOI 10.1210/endrev/bnz009

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Abstract

Nonalcoholic fatty liver disease (NAFLD) is a spectrum of disease, extending from simple steatosis to inflammation and fibrosis with a significant risk for the development of cirrhosis. It is highly prevalent and is associated with significant adverse outcomes both through liver-specific morbidity and mortality but, perhaps more important, through adverse cardiovascular and metabolic outcomes. It is closely associated with type 2 diabetes and obesity, and both of these conditions drive progressive disease toward the more advanced stages. The mechanisms that govern hepatic lipid accumulation and the predisposition to inflammation and fibrosis are still not fully understood but reflect a complex interplay between metabolic target tissues including adipose and skeletal muscle, and immune and inflammatory cells. The ability to make an accurate assessment of disease stage (that relates to clinical outcome) can also be challenging. While liver biopsy is still regarded as the gold-standard investigative tool, there is an extensive literature on the search for novel noninvasive biomarkers and imaging modalities that aim to accurately reflect the stage of underlying disease. Finally, although no therapies are currently licensed for the treatment of NAFLD, there are interventions that appear to have proven efficacy in randomized controlled trials as well as an extensive emerging therapeutic landscape of new agents that target many of the fundamental pathophysiological processes that drive NAFLD. It is highly likely that over the next few years, new treatments with a specific license for the treatment of NAFLD will become available.

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MASLD is a disease spectrum spanning from simple excess triacylglycerol accumulation within hepatocytes (steatosis) to inflammation (MASH), cirrhosis and hepatocellular carcinoma.
“MASLD is a disease spectrum spanning from simple excess triacylglycerol (TAG) accumulation within the hepatocytes (steatosis) to inflammation (metabolic dysfunction-associated steatohepatitis, MASH), cirrhosis and hepatocellular carcinoma (HCC) (3).”
From Diet and physical exercise as key players to tackle MASLD through improvement of insulin resistance and metabolic flexibility (2024) · cites this paper as [3]

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Self-citation
The natural history of nonalcoholic fatty liver disease with advanced fibrosis or cirrhosis: An international collaborative study
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Remission of human type 2 diabetes requires decrease in liver and pancreas fat content but is dependent upon capacity for β cell recovery
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Prospective evaluation of a primary care referral pathway for patients with non-alcoholic fatty liver disease
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NAFLD as a Continuum: From Obesity to Metabolic Syndrome and Diabetes
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Delivery of Oligonucleotides to the Liver with GalNAc: From Research to Registered Therapeutic Drug
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Nonalcoholic Fatty Liver Disease: Modulating Gut Microbiota to Improve Severity?
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Prevalence of Nonalcoholic Fatty Liver Disease (NAFLD) in Patients With Type 1 Diabetes Mellitus: A Systematic Review and Meta-Analysis
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Predictive Role of Neutrophil-Percentage-to-Albumin Ratio (NPAR) in Nonalcoholic Fatty Liver Disease and Advanced Liver Fibrosis in Nondiabetic US Adults: Evidence from NHANES 2017–2018
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Nonalcoholic Fatty Liver Disease Increases the Risk of Anxiety and Depression
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Ursodeoxycholic acid as a means of preventing atherosclerosis, steatosis and liver fibrosis in patients with nonalcoholic fatty liver disease
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Pathophysiological mechanisms and clinical evidence of relationship between Nonalcoholic fatty liver disease (NAFLD) and cardiovascular disease
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Evaluating causality of cellular senescence in non-alcoholic fatty liver disease
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The effects of Ramadan intermittent fasting on liver function in healthy adults: A systematic review, meta-analysis, and meta-regression
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Analysis of environmental chemical mixtures and nonalcoholic fatty liver disease: NHANES 1999–2014
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Natural products in non-alcoholic fatty liver disease (NAFLD): Novel lead discovery for drug development
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Gut–Liver Axis and Non-Alcoholic Fatty Liver Disease: A Vicious Circle of Dysfunctions Orchestrated by the Gut Microbiome
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Amylin and Calcitonin: Potential Therapeutic Strategies to Reduce Body Weight and Liver Fat
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Authors: Marjot, T., Moolla, A., Cobbold, J. F., Hodson, L., & Tomlinson, J. W.
Affiliations: Churchill Hospital (GB)
John Radcliffe Hospital (GB)
Corresponding author: Tomlinson, Jeremy W
ORCID: Marjot, Thomas
Moolla, Ahmad
Cobbold, Jeremy F
Hodson, Leanne
Tomlinson, Jeremy W
Venue: Endocrine Reviews
Publisher: The Endocrine Society
Published: 2019-10-14
Volume: 41
Issue: 1
Pages: 66-117
ISSN: 0163-769X (ISSN-L)
1945-7189
DOI: 10.1210/endrev/bnz009
OpenAlex: W2980992948
Cited by: 228
References: 545
Citations by year: 2026: 12 · 2025: 35 · 2024: 25 · 2023: 46 · 2022: 53 · 2021: 29 · 2020: 23 · 2019: 3
FWCI: 3.94
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
Locations: Endocrine Reviews (publishedVersion)
PubMed (publishedVersion)
Funders: National Institute for Health and Care Research
British Heart Foundation (FS/15/56/31645, FS/11/18/28633)
Department of Health and Social Care
University of Oxford
Novo Nordisk
Medical Research Council (MR/P011462/1)
Biotechnology and Biological Sciences Research Council (BBS/E/F/000PR10347)
NIHR Oxford Biomedical Research Centre
Topics: Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
Health Sciences › Medicine › Hepatology › Liver Diseases and Immunity
Keywords: non-alcoholic fatty liver disease, hepatic steatosis, liver fibrosis, liver cirrhosis, type 2 diabetes, obesity, hepatic lipid accumulation, liver inflammation, disease staging, non-invasive biomarkers, liver imaging, cardiovascular outcomes, metabolic outcomes, NAFLD therapy, adipose tissue, skeletal muscle
MeSH terms: Adult, Diabetes Mellitus, Type 2, Endocrinology, Humans, Liver, Liver Cirrhosis, Prognosis, Prevalence, Non-alcoholic Fatty Liver Disease

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Nonalcoholic fatty liver disease in adults: current concepts in etiology, outcomes, and management

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