Incretin based therapies:A novel treatment approach for non-alcoholic fatty liver disease

Non-alcoholic fatty liver disease is considered a hepatic manifestation of metabolic syndrome(MS).The current treatment of non-alcoholic fatty liver disease(NAFLD)principally includes amelioration of MS components by lifestyle modifications but the lack of success in their implementation and sustainment arises the need for effective pharmacological agent in fatty liver treatment.Incretins are gut derived hormones secreted into the circulation in response to nutrient ingestion that enhances glucose-stimulated insulin secretion.Glucagon-like peptide-1(GLP-1)is the most important incretin.Its receptor agonist and inhibitors of dipeptidyl peptidase-4(DPP-4)are used in treatment of type2 diabetes mellitus.DPP-4 serum activity and hepatic expression are shown to be elevated in several hepatic diseases.There are several experimental and clinical trials exploring the efficacy of incretin based therapies in NAFLD treatment.They suggest that GLP-1 analogues might have beneficial effect on hepatic steatosis acting as insulin sensitizers and directly by stimulating GLP-1 receptors expressed on hepatocytes.The use of DPP-4 inhibitors also results in hepatic fat reduction but the mechanism of action remains unclear.There is growing evidence that incretin based therapies have beneficial effects on hepatocytes,however further study analysis are needed to assess the long term effect of incretin based therapies on NAFLD.

Overview and developments in noninvasive diagnosis of nonalcoholic fatty liver disease

High prevalence of non-alcoholic fatty liver disease (NAFLD) and very diverse outcomes that are related to disease form and severity at presentation have made the search for noninvasive diagnostic tools in NAFLD one of the areas with most intense development in hepatology today.Various methods have been investigated in the recent years,including imaging methods like ultrasound and magnetic resonance imaging,different forms of liver stiffness measurement,various biomarkers of necroinflammatory processes (acute phase reactants,cytokines,markers of apoptosis),hyaluronic acid and other biomarkers of liver fibrosis.Multicomponent tests,scoring systems and diagnostic panels were also developed with the purposes of differentiating non-alcoholic steatohepatitis from simple steatosis or discriminating between various fibrosis stages.In all of the cases,performance of noninvasive methods was compared with liver biopsy,which is still considered to be a gold standard in diagnosis,but is by itself far from a perfect comparative measure.We present here the overview of the published data on various noninvasive diagnostic tools,some of which appear to be very promising,and we address as well some of still unresolved issues in this interesting field.

Risk Factors for Colorectal Adenoma–Acknowledging the Burden of NAFLD

Global trends of diet have changed in Western and Eastern countries,featuring foods that are highly processed,contain saturated fat and carry excessive carbohydrate calories.This,accompanied by lower levels of physical activity,due to a more sedentary lifestyle,and the overweight/obesity epidemic,is the reason we are facing a rise in occurrence of new cases of metabolic syndrome.Furthermore,these patients are at substantial risk of developing the well-known complications related to each of the components of metabolic syndrome,those being insulin resistance/diabetes mellitus,arterial hypertension,hyperlipidemia and visceral obesity.