Neue Entwicklungen in der Diagnostik und Therapie der metabolisch assoziierten, nicht-alkoholischen Fettlebererkrankung

Zusammenfassung

Metabolisch assoziierte, nicht-alkoholische Fettlebererkrankungen (NAFLD) sind ein zunehmendes Gesundheitsproblem und ein wichtiger Einflussfaktor sowohl für die hepatische als auch für die kardiovaskuläre und metabolische Mortalität. Die über die letzten Jahrzehnte rasch zunehmende Prävalenz des metabolischen Syndroms und insbesondere der Adipositas in der westlichen Welt ist die Hauptursache für diesen deutlichen Anstieg der NAFLD und ihrer Folgeerscheinungen ‚nicht-alkoholische Steatohepatitis‘ (NASH) mit ‚NASH-Fibrose‘ und Übergang in eine ‚NASH-Zirrhose‘. Die Pathogenese der NAFLD beinhaltet eine komplexe Interaktion zwischen Umweltfaktoren (z. B. westliche Ernährung), Adipositas, Veränderungen der Mikrobiota und prädisponierenden genetischen Faktoren, die zu einer gestörten Lipidhomöostase mit übermäßiger Fettansammlung in der Leber führen. Insulinresistenz ist ein weiterer zentraler Mechanismus, der zu Lipotoxizität sowie oxidativem Stress und zu einem inflammatorischen Zellschaden in den Hepatozyten führt und bei einem Teil der Patienten letztendlich in einer Fibrogenese mündet. Neue therapeutische Ansätze, die auf einem tieferen Verständnis der molekularen Pathogenese basieren sind daher dringend erforderlich, um das Fortschreiten der Krankheit und insbesondere das Auftreten einer Leberfibrose bzw. Zirrhose zu verhindern. In dem vorliegenden Übersichtsartikel fassen wir aktuelle Daten zur Epidemiologie, Pathogenese, Risikostratifizierung und Therapie der NAFLD zusammen. Ein besonderer Fokus liegt hierbei auf den neuesten Entwicklungen zur interdisziplinär-multimodalen und medikamentösen Therapie.

Abstract

Metabolic associated, non-alcoholic fatty liver disease (NAFLD) is an increasing health care problem and an important factor influencing hepatic, cardiovascular and metabolic mortality. A rapidly increasing prevalence of metabolic syndrome, particularly obesity, in the western world over the past few decades also led to a significant increase in NAFLD and associated complications including the risk of progression to fibrosis and liver cancer development. The pathogenesis of NAFLD involves a complex interaction between environmental factors (e. g. Western diet), obesity, changes in the microbiota and predisposing genetic factors that lead to impaired lipid homeostasis and an excessive accumulation of triglycerides and other lipids in the liver. Insulin resistance is another central mechanism responsible for the induction of lipotoxicity and oxidative stress in the liver leading to inflammatory cell damage and, ultimately, fibrogenesis. A deeper understanding of the molecular pathogenesis is urgently required to prevent the progression of the disease and develop novel therapeutic strategies. In this review article we aim to summarize current data on the epidemiology, pathogenesis, risk stratification and therapy of NAFLD. A special focus will be placed on the latest developments in the field of interdisciplinary and drug therapy.

Schlüsselwörter

Metabolisch assoziierte Fettlebererkrankung - Nicht-alkoholische Fettlebererkrankung - Adipositas

Key words

Metabolic-associated fatty liver disease - non-alcoholic fatty liver disease - obesity

Publication History

Article published online:
24 September 2021

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