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Steatotic liver disease

Epidemiology of metabolic dysfunction-associated steatotic liver disease
Zobair M. Younossi, Markos Kalligeros, Linda Henry
Clin Mol Hepatol 2025;31(Suppl):S32-S50.
Published online August 19, 2024
DOI: https://doi.org/10.3350/cmh.2024.0431
As the rates of obesity and type 2 diabetes (T2D) continue to increase globally, so does the prevalence of metabolic dysfunction–associated steatotic liver disease (MASLD). Currently, 38% of all adults and 7–14% of children and adolescents have MASLD. By 2040, the MASLD prevalence rate for adults is projected to increase to more than 55%. Although MASLD does not always develop into progressive liver disease, it has become the top indication for liver transplant in the United States for women and those with hepatocellular carcinoma (HCC). Nonetheless, the most common cause of mortality among patients with MASLD remains cardiovascular disease. In addition to liver outcomes (cirrhosis and HCC), MASLD is associated with an increased risk of developing de novo T2D, chronic kidney disease, sarcopenia, and extrahepatic cancers. Furthermore, MASLD is associated with decreased health-related quality of life, decreased work productivity, fatigue, increased healthcare resource utilization, and a substantial economic burden. Similar to other metabolic diseases, lifestyle interventions such as a heathy diet and increased physical activity remain the cornerstone of managing these patients. Although several obesity and T2D drugs are available to treat co-morbid disease, resmetirom is the only MASH-targeted medication for patients with stage 2–3 fibrosis that has approved by the Food and Drug Administration for use in the United States. This review discusses MASLD epidemiology and its related risk factors and outcomes and demonstrates that without further global initiatives, MASLD incidence could continue to increase.

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  • Interactions Between the Gut Microbiome and Genetic and Clinical Risk Factors for Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) in Patients with Type 2 Diabetes Mellitus from Different Geographical Regions of Argentina
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    European Journal of Clinical Investigation.2026;[Epub]     CrossRef
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  • Noninvasive Testing for Metabolic Dysfunction-Associated Steatohepatitis (MASH) and Fibrosis
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    International Journal of Molecular Sciences.2026; 27(2): 1069.     CrossRef
  • Association between blood heavy metal levels and subtypes of steatotic liver disease: A nationally representative cross-sectional analysis in South Korea
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    Medicine.2026; 105(4): e47365.     CrossRef
  • Biological aging across the metabolic dysfunction–associated steatotic liver disease spectrum: A systematic review
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    iLIVER.2026; 5(1): 100222.     CrossRef
  • Fermented Foods and the Gut–Liver Axis: Modulation of MASLD Through Gut Microbiota
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    Nutrients.2026; 18(3): 542.     CrossRef
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  • Paulobutalipin, a Lipid Accumulation Inhibitor from a Streptomyces sp.
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  • The active components of the Danshen-Shanzha herb-pair exert a protective effect on MASLD by synergistically promoting fatty acid oxidation via the activation of PPARα, Plin-5 and Plin-2
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  • Detection of hepatic steatosis with ultrasound-guided attenuation parameter (UGAP) in metabolic dysfunction-associated steatotic liver disease (MASLD) compared with proton density fat fraction (PDFF): Impact of measurement number and region of interest (R
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  • MicroRNA-146a Protects against Hepatocellular Carcinoma through Suppression of CCL5
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    Júlia Mayumi Tomaru, Iara Ribeiro Nunes, Caroline Fernandes de Souza Santiago, Alda Maria Machado Bueno Otoboni, Claudemir Gregorio Mendes, Adriana Maria Ragassi Fiorini, Elen Landgraf Guiguer, Claudia Cristina Teixeira Nicolau, Antonelly Cassio Alves Car
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    Madunil Anuk Niriella, Ravini Amila Premaratna, Shashini Hathurusinghe, Ranjan Premaratna, Anuradha Supun Dassanayake, Hithanadura Janaka de Silva
    Journal of Clinical Virology Plus.2026; 6(2): 100247.     CrossRef
  • Toll Like Receptor 4: A Potential Link Between Obesity and Metabolic Diseases
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  • Impact of newer antihyperglycemic agents on hepatic complications: A systematic review and meta-analysis of data from 5.3 million patients with type 2 diabetes mellitus
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  • A novel C/EBPα–miR-335-5p–PRKAA2 regulatory axis drives hepatic lipid accumulation in MASLD
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  • Modulation of metabolic, inflammatory, fibrotic, and cell death pathways by resmetirom in metabolic dysfunction-associated steatohepatitis (MASH): a transcriptomic profiling study
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    Seunghee Byun, Hyunsik Kim, Sun‐Ho Lee, Jae‐Hwan Kwon, Hyunseung Kim, Jung‐Yoon Yoo, Soo‐Yeon Park, Ho‐Geun Yoon
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    European Journal of Gastroenterology & Hepatology.2026; 38(3): 351.     CrossRef
  • Triglyceride glucose index—a body shape index (TyG-ABSI) outperforms traditional obesity indices in predicting all-cause and cardiovascular mortality in metabolic-dysfunction associated steatotic liver disease: the mediating role of biological aging
    Guodong Yang, Wenli He, Xin Qiu, Shuang Shen, Peishu Li, Yifei Feng, Jiayuan Zhang, Bangde Xiang
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    Tugce Apaydin, Haluk Tarik Kani, Caglayan Keklikkiran, Yusuf Yilmaz, Dilek Gogas Yavuz
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    Iwona Gorczyca-Głowacka, Michał Tarnowski, Anna Zmelonek-Znamirowska, Przemysław Wolak
    Journal of Clinical Medicine.2026; 15(4): 1536.     CrossRef
  • Development of a Lipidomics-Based Cell Screening Platform for Indirect Antioxidants Targeting Oxidized Lipid Droplet Formation and Mitochondrial Membrane Abnormality
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    Nutrients.2026; 18(5): 719.     CrossRef
  • Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD): A Multisystemic Narrative Review of Cardiovascular and Oncological Implications
    Menatalla M. A. Mohamed, Maha M. M. I. Taha, Mohnd M. M. R. Ibrahim
    ASIDE Gastroenterology.2026; 2(2): 15.     CrossRef
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  • Fecal microbiota transplantation alleviates steatosis and inflammation in high-fat and high-sugar diet-induced fatty liver in mice
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  • Coagulation protease-activated receptor-2 (PAR2) promotes dyslipidemia, obesity and MASLD through repression of the hepatic pioneer factor HNF4α
    Xinru Chen, Nga Nguyen, Susan E. Turner, Albert K. Tai, Manal F. Abdelmalek, Lidija Covic, Athan Kuliopulos
    JHEP Reports.2026; : 101796.     CrossRef
  • Real-world comparison of GLP-1 agonists versus physical activity in metabolic dysfunction-associated steatotic liver disease
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    Journal of Biological Chemistry.2026; : 111321.     CrossRef
  • Using an integrative multi-omics and in vitro approach to investigate the role of tris(2-butoxyethyl) phosphate in promoting hepatic steatosis
    Gang Zhou, Xihan Gu, Xinyao Zhou, Shuai Chen, Hanyang Liu, Jing Wang
    BMJ Open Gastroenterology.2026; 13(1): e002123.     CrossRef
  • Epigenetic regulation in MASLD – insight for therapeutic target discovery
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    Epigenomics.2026; : 1.     CrossRef
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    Healthcare.2026; 14(5): 579.     CrossRef
  • Targeting magnesium homeostasis: a novel therapeutic strategy for liver diseases
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    Clinics and Practice.2026; 16(3): 57.     CrossRef
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  • MEANDERLINE BASED MICROSTRIP ANTENNA DESIGN FOR LIVER TUMOR DETECTION
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  • Association of sleep patterns and disorders with metabolic dysfunction-associated steatotic liver disease and liver fibrosis in contemporary American adults
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  • Phthalates exposure, biological aging, and increased risks of insulin resistance, prediabetes, and diabetes in adults with metabolic dysfunction-associated steatotic liver disease
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    Katharina L. Hupa-Breier, Heiko Schenk, Alejandro Campos-Murguia, Freya Wellhöner, Benjamin Heidrich, Janine Dywicki, Björn Hartleben, Clara Böker, Julian Mall, Christoph Terkamp, Ludwig Wilkens, Friedrich Becker, Karl Lenhard Rudolph, Michael Peter Manns
    Molecular Metabolism.2025; 93: 102104.     CrossRef
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    Jana Meyer, Ana Mendes Teixeira, Sandy Richter, Dean P. Larner, Asifuddin Syed, Nora Klöting, Madlen Matz-Soja, Susanne Gaul, Anja Barnikol-Oettler, Wieland Kiess, Diana Le Duc, Melanie Penke, Antje Garten
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  • Association of High‐Sensitivity Troponins in Metabolic Dysfunction‐Associated Steatotic Liver Disease With All‐Cause and Cause‐Specific Mortality
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  • Potential bidirectional communication between the liver and the central circadian clock in MASLD
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Letters to the Editor

Steatotic liver disease

Correspondence on Letter regarding “The usefulness of metabolic score for insulin resistance for the prediction of incident non-alcoholic fatty liver disease in Korean adults”
Jun-Hyuk Lee, Kyongmin Park, Hye Sun Lee, Hoon-Ki Park, Jee Hye Han, Sang Bong Ahn
Clin Mol Hepatol 2023;29(1):179-181.
Published online November 22, 2022
DOI: https://doi.org/10.3350/cmh.2022.0409

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Steatotic liver disease

Citations

Citations to this article as recorded by  Crossref logo
  • Correspondence on Letter regarding “The usefulness of metabolic score for insulin resistance for the prediction of incident non-alcoholic fatty liver disease in Korean adults”
    Jun-Hyuk Lee, Kyongmin Park, Hye Sun Lee, Hoon-Ki Park, Jee Hye Han, Sang Bong Ahn
    Clinical and Molecular Hepatology.2023; 29(1): 179.     CrossRef
  • 6,261 View
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  • 1 Web of Science
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Correspondence

Steatotic liver disease

Correspondence on Editorial regarding “Screening and prediction of nonalcoholic fatty liver disease using a peripheral insulin resistance index: Potential benefits and limitations”
Jun-Hyuk Lee, Kyongmin Park, Hye Sun Lee, Hoon-Ki Park, Jee Hye Han, Sang Bong Ahn
Clin Mol Hepatol 2023;29(1):185-187.
Published online November 10, 2022
DOI: https://doi.org/10.3350/cmh.2022.0375
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Editorial

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Review

Hepatic neoplasm

Development and prognosis of hepatocellular carcinoma in patients with diabetes
Takuma Nakatsuka, Ryosuke Tateishi
Clin Mol Hepatol 2023;29(1):51-64.
Published online July 29, 2022
DOI: https://doi.org/10.3350/cmh.2022.0095
The incidence of diabetes mellitus and hepatocellular carcinoma (HCC) has been increasing worldwide during the last few decades, in the context of an increasing prevalence of obesity and non-alcoholic fatty liver disease (NAFLD). Epidemiologic studies have revealed that patients with diabetes have a 2- to 3-fold increased risk of developing HCC, independent of the severity and cause of the underlying liver disease. A bidirectional relationship exists between diabetes and liver disease: advanced liver disease promotes the onset of diabetes, and HCC is an important cause of death in patients with diabetes; conversely, diabetes is a risk factor for liver fibrosis progression and HCC development, and may worsen the long-term prognosis of patients with HCC. The existence of close interconnections among diabetes, obesity, and NAFLD causes insulin resistance-related hyperinsulinemia, increased oxidative stress, and chronic inflammation, which are assumed to be the underlying causes of hepatocarcinogenesis in patients with diabetes. No appropriate surveillance methods for HCC development in patients with diabetes have been established, and liver diseases, including HCC, are often overlooked as complications of diabetes. Although some antidiabetic drugs are expected to prevent HCC development, further research on the optimal use of antidiabetic drugs aimed at hepatoprotection is warranted. Given the increasing medical and socioeconomic impact of diabetes on HCC development, diabetologists and hepatologists need to work together to develop strategies to address this emerging health issue. This article reviews the current knowledge on the impact of diabetes on the development and progression of HCC.

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Original Articles

The usefulness of metabolic score for insulin resistance for the prediction of incident non-alcoholic fatty liver disease in Korean adults
Jun-Hyuk Lee, Kyongmin Park, Hye Sun Lee, Hoon-Ki Park, Jee Hye Han, Sang Bong Ahn
Clin Mol Hepatol 2022;28(4):814-826.
Published online June 9, 2022
DOI: https://doi.org/10.3350/cmh.2022.0099
Background/Aims
The early detection and prevention of non-alcoholic fatty liver disease (NAFLD) has been emphasized considering the burden of this disease. Both hepatic and peripheral insulin resistances are strongly associated with NAFLD. We aimed to compare the predictive powers of a hepatic insulin resistance index, the homeostatic model assessment for insulin resistance (HOMA-IR), and a novel peripheral insulin resistance index, the metabolic score for insulin resistance (METS-IR), for the prediction of prevalent and incident NAFLD.
Methods
Data from 8,360 adults aged 40–69 years at baseline and 5,438 adults without NAFLD who were followed-up at least once after the baseline survey in the Korean Genome and Epidemiology Study were analyzed. The survey was performed biennially, up to the eighth follow-up.
Results
The predictive powers of the METS-IR and HOMA-IR for prevalent NAFLD were not significantly different (area under the receiver operating characteristic [ROC] curve [95% confidence interval]: METS-IR, 0.824 [0.814–0.834]; HOMAIR, 0.831 [0.821–0.842]; P=0.276). The area under the time-dependent ROC curve (Heagerty’s integrated area under the curve) of the METS-IR for incident NAFLD was 0.683 (0.671–0.695), significantly higher than that of the HOMA-IR (0.551 [0.539–0.563], P<0.001).
Conclusions
The METS-IR is superior to the HOMA-IR for the prediction of incident NAFLD and is not inferior to the HOMA-IR for the prediction of prevalent NAFLD. This suggests that the METS-IR can be a more useful insulin resistance index than the HOMA-IR for the early detection and prevention of NAFLD in Korean population.

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Viral hepatitis

The impact of pegylated interferon and ribavirin combination treatment on lipid metabolism and insulin resistance in chronic hepatitis C patients
Hee Jae Jung, Young Seok Kim, Sang Gyune Kim, Yun Nah Lee, Soung Won Jeong, Jae Young Jang, Sae Hwan Lee, Hong Soo Kim, Boo Sung Kim
Clin Mol Hepatol 2014;20(1):38-46.
Published online March 26, 2014
DOI: https://doi.org/10.3350/cmh.2014.20.1.38
Background/Aims

Lipid profile and insulin resistance (IR) are associated with hepatitis C virus (HCV) and may predict the chronic hepatitis C (CHC) treatment response. The aim of this study was to determine the association between CHC treatment response and lipid profile and IR change during treatment.

Methods

In total, 203 CHC patients were reviewed retrospectively between January 2005 and December 2011 at Soon Chun Hyang University Hospital. The lipid profile, homeostasis model for assessment (HOMA) of IR (HOMA-IR), and HOMA of β cells (HOMA-β) were evaluated before interferon plus ribavirin therapy (BTx), at the end of treatment (DTx), and 24 weeks after the end of treatment (ATx).

Results

A sustained virologic response (SVR) was achieved by 81% of all patients (49/60), 60% (n=36) of whom possessed genotype 1, with the remainder being non-genotype-1 (40%, n=24). Apart from age, which was significantly higher in the non-SVR group (SVR, 48.0±11.2 years, mean±SD; non-SVR, 56.6±9.9 years; P<0.01), there were no significant differences in the baseline characteristics between the SVR and non-SVR groups. In the SVR group, low density lipoprotein-cholesterol (LDL-C) had significantly changed at DTx and ATx compared to BTx. In addition, HOMA-IR and HOMA-β were significantly changed at DTx in the SVR group. Among those with a high baseline insulin resistance (HOMA-IR >2.5), HOMA-IR was significantly changed at DTx in the SVR group.

Conclusions

LDL-C appears to be associated with HCV treatment in SVR patients. Furthermore, eradication of HCV may improve whole-body IR and insulin hypersecretion, as well as high baseline insulin resistance (HOMA-IR >2.5).

Citations

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Steatotic liver disease

The influence of waist circumference on insulin resistance and nonalcoholic fatty liver disease in apparently healthy Korean adults
Deok Yun Ju, Young Gil Choe, Yong Kyun Cho, Dong Suk Shin, Su Hyeon Yoo, Seo Hyoung Yim, Ji Yong Lee, Jung Ho Park, Hong Joo Kim, Dong Il Park, Chong Il Sohn, Woo Kyu Jeon, Byung Ik Kim
Clin Mol Hepatol 2013;19(2):140-147.
Published online June 27, 2013
DOI: https://doi.org/10.3350/cmh.2013.19.2.140
Background/Aims

Waist circumference (WC) is a risk factor for metabolic syndrome and is related to insulin resistance (IR) and nonalcoholic fatty liver disease (NAFLD). The purpose of this study was to determine the association between WC and IR and NAFLD in apparently healthy Korean adults.

Methods

The volunteers included in this cross-sectional study comprised 9,159 adults (5,052 men, 4,107 women) who participated in a comprehensive health checkup program. IR was evaluated by the homeostasis model assessment of IR (HOMA-IR) and was considered to be present when the HOMA-IR score was >2. NAFLD was evaluated by ultrasound examination. Elevated alanine aminotransferase (ALT) was defined as >40 IU/L in men and >35 IU/L in women. Logistic regression was performed to determine the odds ratios (ORs) and 95% confidence intervals (95% CIs) for NAFLD, IR, and ALT according to categorized levels of WC.

Results

NAFLD was found in 2,553 (27.9%) of the participants (82.6% men, 17.4% women), while IR and elevated ALT were found in 17.2% (68.1% men, 31.9% women) and 10% (83% men, 17% women), respectively. After adjusting for confounding factors, the prevalence of NAFLD, IR, and elevated ALT was significantly associated with increases in WC quartile: highest quartile for NAFLD in men, OR=15.539, 95% CI=12.687-19.033; highest quartile for NAFLD in women, OR=48.732, 95% CI=23.918-99.288 (P<0.001); and highest quartile for IR in men, OR=17.576, 95% CI=13.283-23.255; highest quartile for IR in women, OR=11.078, 95% CI=7.813-15.708 (P<0.001); highest quartile for elevated ALT in men, OR=7.952, 95% CI=6.046-10.459; and highest quartile for elevated ALT in women, OR=8.487, 95% CI=4.679-15.395 (P<0.001).

Conclusions

WC contributes to IR and NAFLD in apparently healthy Korean adults, and thus may be an important factor in the development of IR and NAFLD.

Citations

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    Arquivos de Gastroenterologia.2022; 59(3): 402.     CrossRef
  • Identify Functional lncRNAs in Nonalcoholic Fatty Liver Disease by Constructing a ceRNA Network
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  • Anthropometric clinical indicators of visceral adiposity as predictors of nonalcoholic fatty liver disease
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  • Waist-to-height ratio, an optimal anthropometric indicator for metabolic dysfunction associated fatty liver disease in the Western Chinese male population
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    Lipids in Health and Disease.2021;[Epub]     CrossRef
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    Journal of Korean Medical Science.2020;[Epub]     CrossRef
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    Pegah Golabi, James M. Paik, Tamoore Arshad, Youssef Younossi, Alita Mishra, Zobair M. Younossi
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Review

Nonalcoholic steatohepatitis: Pathogenesis and treatment
Sang Hoon Park
Korean J Hepatol 2008;14(1):12-27.
Published online March 20, 2008
DOI: https://doi.org/10.3350/kjhep.2008.14.1.12
Nonalcoholic fatty liver disease (NAFLD) is characterized by a wide spectrum of liver damage spanning steatosis, nonalcoholic steatohepatitis (NASH), cryptogenic liver cirrhosis, and even to hepatocellular carcinoma. Investigations in the last few years have focused on NASH, a relatively aggressive form of liver disease, due largely to the explosion of information provided by clinical and basic science studies related to the widespread presence of risk factors, such as obesity, type II diabetes mellitus, and dyslipidemia. This is especially important given that obesity and type II diabetes mellitus have recently reached epidemic proportions in Korea. The pathogenesis of NASH is multifactorial, with insulin resistance and increased fatty acid possibly being important factors in the accumulation of hepatocellular fat, and oxidant stress, lipid peroxidation, mitochondrial dysfunction, and dysregulation of variable cytokines possibly being important causes of hepatocellular injury in steatotic liver. Because not all steatotic livers progress to NASH, some other environmental factors or a combination of genetic factors are thought to be required for progression to NASH and fibrosis. Lifestyle modifications continue to be the cornerstone therapy in NAFLD, but some insulin-sensitizing drugs might be more effective in treating NASH. Many pilot trials for antioxidants and lipid-lowering and hepatic protective agents have yielded promising initial results in improving liver enzymes or features of liver histology. However, the efficacy of these agents remains questionable. Despite recent gains in understanding NASH, several issues related to its natural history, pathogenesis, and treatment remain unresolved. (Korean J Hepatol 2008;14:12- 27)

Citations

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  • Elevated red cell distribution width is associated with advanced fibrosis in NAFLD
    Hwa Mok Kim, Bum Soo Kim, Yong Kyun Cho, Byung Ik Kim, Chong Il Sohn, Woo Kyu Jeon, Hong Joo Kim, Dong Il Park, Jung Ho Park, Kwan Joong Joo, Chang Joon Kim, Yong Sung Kim, Woon Je Heo, Won Seok Choi
    Clinical and Molecular Hepatology.2013; 19(3): 258.     CrossRef
  • Validity and reliability of the nonalcoholic fatty liver diseases activity score (NAS) in Korean NAFLD patients and its correlation with clinical factors
    Kyung-Hun Lee, Sang Hoon Park, Yu Jin Kim, Kyung Rim Huh, Kwang Seon Min, Sun-Young Jun, Kyoung Oh Kim, Cheol Hee Park, Taeho Hahn, Kyo-Sang Yoo, Jong Hyeok Kim, Myung-Seok Lee, Choong Kee Park
    The Korean Journal of Hepatology.2010; 16(1): 29.     CrossRef

  • Ko NOMURA
    Environmental Education.2010; 20(1): 6.     CrossRef
  • Pathology of nonalcoholic steatohepatitis
    Yoon-Mi Jeen, So-Young Jin
    The Korean Journal of Hepatology.2009; 15(2): 122.     CrossRef
  • The epidemiology of hepatocellular cancer: from the perspectives of public health problem to tumor biology
    Stephen Caldwell, Sang H. Park
    Journal of Gastroenterology.2009; 44(S19): 96.     CrossRef
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Editorial

Nonalcoholic fatty Liver disease as a risk factor of cardiovascular disease
Moon Young Kim , Soon Koo Baik
Korean J Hepatol 2008;14(1):1-3.
Published online March 20, 2008
DOI: https://doi.org/10.3350/kjhep.2008.14.1.1

Citations

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  • Fibrinogen production is enhanced in an in-vitro model of non-alcoholic fatty liver disease: an isolated risk factor for cardiovascular events?
    Emily N. W. Yeung, Philipp Treskes, Sarah F. Martin, Jonathan R. Manning, Donald R. Dunbar, Sophie M. Rogers, Thierry Le Bihan, K. Ann Lockman, Steven D. Morley, Peter C. Hayes, Leonard J. Nelson, John N. Plevris
    Lipids in Health and Disease.2015;[Epub]     CrossRef
  • Prevalence of Metabolic Syndrome and Related Risk Factors of Elderly Residents in Andong Rural Area 2. Based on the Biochemical Measurements and Nutrient Intakes
    Hye-Sang Lee, Chong-Suk Kwon
    Journal of the Korean Society of Food Science and Nutrition.2010; 39(10): 1459.     CrossRef
  • 6,326 View
  • 67 Download
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Reviews

Special Liver Cirrhosis and Diabetes Mellitus
Yong Soo Park,Tae Wha Kim
Korean J Hepatol 2002;8(1):22-34.
  • 3,213 View
  • 18 Download
Insulin Resistance in Non-Alcoholic Fatty Liver Disease
Jeong Hyun Park
Korean J Hepatol 2006;12(1):16-30.
Insulin resistance is the pathophysiological hallmark of various kinds of clinical diseases, including non- alcoholic fatty liver disease. Insulin resistance is the common characteristic of metabolic syndrome and its related features. Insulin resistance is a systemic disease that affects the nervous system, muscles, pancreas, kidney, heart and immune system, in addition to the liver. A complex interaction between genes and environment factors enhances insulin resistance and the phenotypic expression of NAFLD (non- alcoholic fatty liver disease) in individual patients. Advanced fibrotic liver disease is associated with many features of metabolic syndrome, and the risk of progressive liver disease should not be underestimated for the individuals suffering with metabolic disorders. Abnormalities of insulin signaling can cause the state of insulin resistance, but there is no clear cut scientific evidence that distorted insulin signaling is the primary pathophysiological defect. Increased adipose tissue mass can cause peripheral tissue insulin resistance via the changes of the adipocytokine secretory patterns. We discuss in this article the sequences of the insulin signaling cascades and the possible molecular targets of insulin resistance, the humoral “cross talk” between the distorted secretory patterns of the adipocytokines, and the peripheral tissue insulin resistance along with the pathophysiology of NAFLD. (Korean J Hepatol 2006;12:16-30)
  • 3,862 View
  • 28 Download
Original Article
Background
/Aim: The liver plays important roles in the homeostasis of glucose metabolism since it acts as a major target organ for insulin and a site for gluconeogenesis and glycogen storage. Diabetes mellitus (DM) commonly develops in patients with liver cirrhosis as the result of hepatocyte dysfunction and/or inadequate mass. To assess differences between DM due to liver cirrhosis (hepatogenous DM) and the other type 2 DM, we compared the patterns of hyperglycemia and hyperinsulinemia in hepatogenous DM with those observed in type 2 DM. Methods: 18 diabetic patients with liver cirrhosis (caused by alcohol, n=8; HBV, n=5; HCV, n=2; others, n=3) were matched with 18 type 2 diabetic patients without liver cirrhosis for age and gender. None of the patients or controls had been treated with insulin or β-blockers. The level of glycosylated hemoglobin (HbA1C), fasting plasma glucose (FPG), postprandial plasma glucose (PP2h), fasting plasma C-peptide and insulin were measured. Results: The ratio of PP2h/FPG (2.27 vs. 1.69), fasting insulin (23.2: 11.6 ?IU/mL) and HOMA-IR index (8.38 vs. 3.52) were significantly higher in hepatogenous DM than the other type 2 DM (P<0.05). PP2h, fasting C-peptide and ratio of fasting insulin/C-peptide tend to be higher in hepatogenous DM than those of controls, but which were not statistically significant. Conclusions: The ratio of PP2h/FPG and fasting plasma insulin differentiated hepatogenous DM from the other type 2 DM. Insulin resistance in liver cirrhosis was higher than the other type 2 DM, and impaired hepatic insulin degradation might be an important mechanism of hyperinsulinemia in liver cirrhosis. (Korean J Hepatol 2006;12:524-529)
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