Abstract
Background and aims
Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disorder worldwide. This historical narrative traces the evolution from basic descriptions of fatty liver in the nineteenth century to contemporary understanding of NAFLD in the twentieth and twenty-first centuries.
Methods
Detailed historiographic review of fatty liver from 1800s onwards and a brief review of contemporary associations.
Results
Archived published literature dating back to the 1800s describe clinicopathological features of fatty liver. In the nineteenth century, doyens of medicine associated fatty liver with alcohol, malnutrition or wasting conditions, and subsequently adiposity, unhealthy diets and sedentary lifestyle. Microscopically, fatty liver was described when five percent or more of hepatocytes were distended with fat. Recommendations to reverse fatty liver included reducing consumption of fat, sugar, starchy carbohydrates and alcohol, plus increasing physical exercise. Fatty liver was associated with liver fibrosis and cirrhosis in the late-1800s, and with diabetes in the early-1900s. The diagnostic labels NAFLD and nonalcoholic steatohepatitis (NASH) were introduced in the late-1900s. Metabolic dysfunction-associated fatty liver disease (MAFLD) was recently proposed to update the nosology of fatty liver, recognising the similar metabolic pathogenesis evident in individuals with typical NAFLD and those with heterogenous “secondary” co-factors including alcohol and other aetiologies.
Conclusions
Fatty liver has emerged from being considered a disorder of nutrition extremes or alcohol excess to contemporary recognition as a complex metabolic disorder that risks progression to cirrhosis and hepatocellular cancer. The increasing prevalence and knowledge regarding the lifestyle and metabolic determinants that have informed understanding of NAFLD over nearly two centuries justify the current exercise of re-examining the evolution of this common metabolic disorder.
Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disorder worldwide. This historical narrative traces the evolution from basic descriptions of fatty liver in the nineteenth century to contemporary understanding of NAFLD in the twentieth and twenty-first centuries.
Methods
Detailed historiographic review of fatty liver from 1800s onwards and a brief review of contemporary associations.
Results
Archived published literature dating back to the 1800s describe clinicopathological features of fatty liver. In the nineteenth century, doyens of medicine associated fatty liver with alcohol, malnutrition or wasting conditions, and subsequently adiposity, unhealthy diets and sedentary lifestyle. Microscopically, fatty liver was described when five percent or more of hepatocytes were distended with fat. Recommendations to reverse fatty liver included reducing consumption of fat, sugar, starchy carbohydrates and alcohol, plus increasing physical exercise. Fatty liver was associated with liver fibrosis and cirrhosis in the late-1800s, and with diabetes in the early-1900s. The diagnostic labels NAFLD and nonalcoholic steatohepatitis (NASH) were introduced in the late-1900s. Metabolic dysfunction-associated fatty liver disease (MAFLD) was recently proposed to update the nosology of fatty liver, recognising the similar metabolic pathogenesis evident in individuals with typical NAFLD and those with heterogenous “secondary” co-factors including alcohol and other aetiologies.
Conclusions
Fatty liver has emerged from being considered a disorder of nutrition extremes or alcohol excess to contemporary recognition as a complex metabolic disorder that risks progression to cirrhosis and hepatocellular cancer. The increasing prevalence and knowledge regarding the lifestyle and metabolic determinants that have informed understanding of NAFLD over nearly two centuries justify the current exercise of re-examining the evolution of this common metabolic disorder.
| Original language | English |
|---|---|
| Article number | 100261 |
| Journal | JHEP Reports |
| Volume | 3 |
| Issue number | 3 |
| DOIs | |
| Publication status | Published - Jun 2021 |
