Obesity and Liver Diseases – From Steatosis to Cirrhosis

Visceral adipose tissue secretes most free fatty acids, hormones, and adipokines; the latter can influence hepatic tissue function. For example, tumor necrosis factor-alpha (TNF-alpha) can act in the progression from simple steatosis to non-alcoholic steatohepatitis (NASH) by inducing apoptosis and inflammatory responses in hepatocytes. This occurs when TNF-alpha activates nuclear factor Kb via the TNF receptor (TNF-R1) as a central transcription factor for many pro-inflammatory cytokines, in addition to inducing lipogenesis in hepatocytes, leading to lipid accumulation in the region. Therefore, tumor necrosis factor-alpha is one of the critical factors for the occurrence and progression of NASH and non-alcoholic fatty liver disease (NAFLD).

Fig. 1. Influence of visceral adipose tissue on NAFLD. Visceral adipose tissue secretes a variety of proteins, known as adipokines, which can influence the liver. FFAs play a major role in the development of simple steatosis. With the influence of adipokines like TNF-alpha, simple steatosis can progress to NASH by induction of apoptosis and inflammation. Apart from adiponectin, which can prevent the development of NASH, cirrhosis, and even HCC, most adipokines exert a negative influence on liver diseases. An elevated BMI may increase the incidence of many cancers, including HCC.

Obesity is strongly associated with non-alcoholic fatty liver disease (NAFLD), which has become a common disease in North American countries, affecting approximately 30% of the population. This disease is characterized by hepatic steatosis but without a history of alcohol consumption, which leads to the consideration that the main risk factor for this disease is obesity.

There are two types of NAFLD: primary and secondary. Primary NAFLD originates from metabolic syndrome, and secondary NAFLD is due to infections, medication intake, parenteral nutrition, or rare congenital metabolic diseases. Histopathologically, NAFLD can appear as simple hepatic steatosis or with inflammatory reactions defined as NASH, with or without the appearance of fibrosis.

It is important to understand the role of obesity, the metabolic disorder, and the lipotoxicity that the disease can cause, and from this, to develop treatments to combat obesity in a healthy and safe manner.

WREE, Alexander; KAHRAMAN, Alisan; GERKEN, Guido; CANBAY, Ali. Obesity Affects the Liver – The Link between Adipocytes and Hepatocytes. Digestion 2011;83:124–133. Department of Gastroenterology and Hepatology, University of Duisburg-Essen, University Clinic Essen, Essen, Germany.

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