Published online Jun 8, 2015. doi: 10.4254/wjh.v7.i10.1325
Peer-review started: August 15, 2014
First decision: November 27, 2014
Revised: December 1, 2014
Accepted: March 16, 2015
Article in press: March 18, 2015
Published online: June 8, 2015
Non-alcoholic fatty liver disease (NAFLD) represents the most common and emerging chronic liver disease worldwide. It includes a wide spectrum of liver diseases ranging from simple fatty liver to non-alcoholic steatohepatitis (NASH), which may progress to fibrosis and more severe liver complications such as cirrhosis, hepatocellular carcinoma and liver mortality. NAFLD is strongly associated with obesity, insulin resistance, hypertension, and dyslipidaemia, and is now regarded as the liver manifestation of the metabolic syndrome. The increased mortality of patients with NAFLD is primarily a result of cardiovascular disease and, to a lesser extent, to liver related diseases. Increased oxidative stress has been reported in both patients with NAFLD and patient with cardiovascular risk factors. Thus, oxidative stress represents a shared pathophysiological disorder between the two conditions. Several therapeutic strategies targeting oxidative stress reduction in patients with NAFLD have been proposed, with conflicting results. In particular, vitamin E supplementation has been suggested for the treatment of non-diabetic, non-cirrhotic adults with active NASH, although this recommendation is based only on the results of a single randomized controlled trial. Other antioxidant treatments suggested are resveratrol, silybin, L-carnitine and pentoxiphylline. No trial so far, has evaluated the cardiovascular effects of antioxidant treatment in patients with NAFLD. New, large-scale studies including as end-point also the assessment of the atherosclerosis markers are needed.
Core tip: Non-alcoholic fatty liver disease (NAFLD) represents the most common chronic liver disease, including a wide spectrum of conditions ranging from simple fatty liver to non-alcoholic steatohepatitis, cirrhosis, hepatocellular carcinoma and liver mortality. NAFLD is considered the liver manifestation of the metabolic syndrome. The increased mortality of patients with NAFLD is primarily a result of cardiovascular disease (CVD). Oxidative stress represents a shared pathophysiological disorder between NAFLD and CVD. Several antioxidant treatments have been proposed in patients with NAFLD, with conflicting results, but no trial has evaluated their cardiovascular effects in this setting. Further studies are needed.