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Researchers have discovered new causes for non-alcoholic fatty liver
Around every third person in Germany has fatty liver. The alcohol-related fatty liver is caused by excessive alcohol consumption. Non-alcoholic fatty liver disease (NAFL) mostly occurs in people who do not exercise enough, who are severely overweight and / or diabetic, or who eat incorrectly. Researchers have now discovered a new cause for NAFL.
According to the German Liver Foundation, around a third of adults have an enlarged liver due to fat storage - and the number is constantly increasing. Every third overweight child has a fatty liver. A distinction is made between a non-alcoholic fatty liver (NAFL) and an alcoholic fatty liver (AFL). In addition to improper nutrition, lack of exercise and obesity, high alcohol consumption or diabetes, the causes that mostly lead to fatty liver in combinations. Researchers from Tübingen have now discovered another cause.
Even slim people have fatty liver
According to a message from the University Hospital in Tübingen, it is believed that the worldwide epidemic of non-alcoholic fatty liver disease (NAFLD) is mainly caused by an unhealthy lifestyle with little physical activity and a diet high in saturated fats, sugar and fructose.
In these overweight and obese patients, weight loss caused by lifestyle changes is considered the most effective and safest method of treating NAFLD and reducing the risk of advanced forms of liver disease such as cirrhosis or liver cancer, type 2 Diabetes and cardiovascular diseases.
NAFLD is also found in slim people. These sufferers either have a genetic change in subcutaneous fat (lipodystrophy), acquired lipodystrophy syndromes, or HIV lipodystrophy, all of which are characterized by a dramatic decrease in subcutaneous fat mass and an increase in fat in the abdomen and liver.
New cause of acquired lipodystrophy discovered
Thomas Eigenler and Diana Lomberg from the University Dermatological Clinic Tübingen as well as Jürgen Machann and Norbert Stefan from the Department of Internal Medicine IV at the University Hospital Tübingen, the Helmholtz Center Munich and the German Center for Diabetes Research (DZD) have now discovered a new cause for the acquired lipodystrophy .
The researchers report on the case of a 45-year-old patient diagnosed with malignant melanoma, a skin cancer that was effectively treated with the programmed cell death protein 1 (PD-1) inhibitor (immune checkpoint inhibitor) nivolumab.
According to the scientists, this and other immune checkpoint inhibitors have revolutionized the treatment of cancer, especially malignant melanoma.
Cancer therapy is associated with adverse events
Therapy with these immune checkpoint inhibitors is also associated with adverse events, which often affect the skin, the gastrointestinal tract, the lungs and the endocrine system. Towards the end of the treatment with nivolumab, Stefan and colleagues found very high lipid levels, newly developed diabetes and a severe form of NAFLD in their patient.
This came completely unexpected, mainly because the patient lost 31 kilograms of body weight. Tissue biopsy of her subcutaneous adipose tissue and magnetic resonance imaging, as stated in the release, diagnosed acquired lipodystrophy with a severe form of inflammation of her adipose tissue.
This could have been triggered in the woman by the immunomodulatory function of immune checkpoint inhibitors, especially since the patient was previously diagnosed with asymptomatic mastocytosis, an immune cell-related disorder.
Intensive pharmacological treatment, especially with pioglitazone, which causes an increase in the subcutaneous fat, resulted in her liver fat, liver enzymes and lipid levels being almost back to normal.
The results of the Tübingen researchers were published in the journal "Annals of Internal Medicine".
Inflammation of the adipose tissue can occur
Norbert Stefan, professor of diabetology at the University of Tübingen and visiting professor at Harvard Medical School in Boston, comes to the conclusion that “it is important that clinicians who treat patients with checkpoint inhibitors relate to a newly identified adverse event are aware of such therapy. "
According to the doctor, inflammation of the fatty tissue can occur, which leads to a severe fatty liver. Specific pharmacotherapy, which includes mechanisms for increasing the subcutaneous fat mass and thus for storing the lipids in a safe storage space, could be helpful for these patients. (ad)
Author and source information
This text corresponds to the requirements of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
- University Hospital Tübingen: fatty liver in slim people - Tübingen researchers discover a new cause, (retrieval: 04.03.2020), University Hospital Tübingen
- Thomas Eigenler, MD; Diana Lomberg, MD; Jürgen Machann, PhD; Norbert Stefan, MD: Lipodystrophic Nonalcoholic Fatty Liver Disease Induced by Immune Checkpoint Blockade; in: Annals of Internal Medicine, (published: 03.03.2020), Annals of Internal Medicine
- German Liver Foundation: Inflammation of fatty liver (steatohepatitis) - the most common liver disease in Germany, (accessed: March 4, 2020), German Liver Foundation