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Abstracts Poster Abstracts - Dr Falk

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Fat, diabetes and liver injuryVlad RatziuHôpital Pitié-Salpêtrière and Université Pierre et Marie Curie, Paris, FranceNonalcoholic steatohepatitis (NASH) is a condition characterized by excessivedeposition of fat in the liver (steatosis), inflammation and hepatocellular necrosis.While steatosis alone is generally a benign and stable condition, NASH can have adire prognosis in a minority of patients, mainly because of fibrosis occurrence andprogression to cirrhosis. Life-threatening complications such as liver failure andhepatocellular carcinoma have been described in NASH-induced cirrhosis. Insulinresistance is almost universally found in patients with NASH and the main risk factorsfor this condition are overweight and diabetes. Improvement in insulin sensitivity,whether achieved by diet, exercise and/or pharmacological interventions, results in adramatic reduction of liver fat and inflammation and fibrosis as well. Therefore NASHshould be viewed as the hepatic phenotypic manifestation of insulin resistance and abona fide component of the metabolic syndrome. Liver injury should be assessed indiabetic and/or obese patients and the mechanisms by which insulin resistancepromotes liver damage needs to be elucidated. Diet and lifestyle modifications arekey to the treatment of this disease. Substantial weight loss significantly improveshistological lesions in NASH but often requires a surgical intervention. Theencouraging results of the use of insulin sensitizers in particular PPAR( agonists inhuman or experimental models of NASH, justifies future large-scale, randomizedcontrolled trials. The efficacy of anti-oxydants and/or hepatoprotective agents has yetto be proven.53

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