Abstract

The term “non-alcoholic fatty liver disease” (NAFLD) was first introduced by Ludwig in 1980. He described NAFLD as a liver disease characterized by lipid accumulation in the hepatocytes of people who do not abuse alcohol (<20g/ethanol/day). NAFLD comprises of a range of disorders, including simple fatty liver without the symptoms of damaged hepatocytes, as well as complex fatty liver with an ongoing inflammation and developing fibrosis. It is estimated that 2-44% of adult Europeans will develop a fatty liver. The pathogenesis and development of NAFLD is a complicated process involving numerous factors, such as: dyslipidemia, insulin resistance, overweight, obesity, mitochondrial dysfunction, oxidative stress, the development of an inflammatory state, the disorders of the metabolism of fat tissue, dysbiosis and genetic factors. Because the mechanism of the illness is based on many factors, the multiple hits hypothesis serves as the new and generally standard approach to this pathological unit. The basis of this theory is the development of insulin resistance, which is one of the main causes of steatosis. The consequence of insulin resistance is an increased glucose level (associated with impaired insulin receptors) and excessive insulin production leading to elevated levels of this hormone in the serum. Insulin resistance causes continuous stimulation of gluconeogenesis and hyperglycemia. On the other hand, hyperinsulinemia stimulates the hepatic synthesis of the de novo lipogenesis and leads to steatosis. NAFLD is also closely connected to the metabolism disorders of fatty acids. The pathomechanism of the illness includes an increased concentration of FFA in blood, an increase in the biosynthesis of fatty acids in the liver, as well as disorders in the process of β-oxidation.

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