Obesity and NAFLD

Abstract

Obesity is currently considered the main health challenge of the twenty-first century. It is a chronic pro-inflammatory disease which systemically affects normal physiology and metabolism, causing multiple associated diseases such as cardiovascular disease, diabetes, nonalcoholic fatty liver disease (NAFLD), and several types of cancer, among others. The main contributors for NAFLD development and progression include high concentrations of diet and adipose tissue-derived free fatty acids and pro-inflammatory adipocytokines. These fatty acids are released from adipocytes and/or from dietary intake and are delivered to the liver. The fatty acids in the hepatocytes can then be oxidized by the mitochondria or converted into triglycerides for intracellular accumulation. With elevated mitochondrial oxidation levels, there is an overproduction of reactive oxygen species and other species that mediate hepatic injury, inflammation, and apoptosis. In order to manage obesity and NAFLD, nutritionally based body weight management is the principal modifiable risk factor. Thus, dietary interventions for body weight loss should be the main therapeutic approach, although pharmacotherapy and, in some specific situation, surgical or bariatric endoscopic interventions may be necessary.