Non-alcoholic fatty liver disease: features of metabolic changes at different stages of the disease

Background. Non-alcoholic fatty liver disease (NAFLD) is a chronic diffuse liver pathology that includes simple steatosis, non-alcoholic steatohepatitis with the risk of progression to cirrhosis or even hepatocellular carcinoma. There are many causes of hepatic steatosis, but NAFLD is associated primarily with insulin resistance and metabolic syndrome, which gave grounds for considering NAFLD as a hepatic manifestation of the last one. The liver plays a key role in the metabolism of fatty acids and trigly­cerides, providing synthesis, accumulation, secretion and oxidation of fatty acids. With abdominal obesity inherent to metabolic syndrome, an excessive flow of fatty acids from visceral fat through the portal vein into the liver is noted, with the development of steatosis. The accumulation of lipids in the liver triggers a cascade of prooxidant hepatotoxic events that lead to the development of non-alcoholic steatohepatitis and its possible progression. The purpose was to establish the features of metabolic changes at different stages of NAFLD. Materials and methods. The study included patients with NAFLD, who underwent examination and treatment at the department of liver and pancreatic diseases of the Institute of Gastroenterology of the NAMS of Ukraine. All patients underwent ultrasonography of the abdominal organs, standard biochemical tests and evaluation of blood serum level of total cholesterol, b-lipoproteins, triglycerides, low-density lipoproteins, very-low-density lipoproteins, high-density lipoproteins, glucose, insulin and C-peptide. The HOMA index was used to assess insulin resistance. Results. Metabolic changes in the form of insulin resistance and proatherogenic changes pn the lipidogram, which are characteristic for all patients with NAFLD, were more significant in liver steatosis. Conclusions. Results of our study necessitate the mandatory study of lipid and carbohydrate metabolism in patients with NAFLD for timely correction of disorders, which will reduce the progression of this disease