Non-alcoholic Fatty Liver Disease (NAFLD), a Growing Pathological Process

A recent article was published discussing the multi-organ effects of a fatty liver.¹ Non-alcoholic fatty liver disease (NAFLD) is a growing pathological process in the industrialized world. It is associated with metabolic syndrome, insulin resistance, obesity, but the long-term effects of NAFLD on other organs has not been specifically addressed in the literature. It is known that hepatokines are produced in excess as part of the pathogenesis of NAFLD, and these hepatokines are being implicated in other organ dysfunction, especially insulin resistance.² glucose and undesirable fats are also secreted from the dysfunctional liver.

Fetuin-A and its Effects on the Pancreas and Kidneys

The primary hepatokine which was looked at for the current study was fetuin-A, and its specific effects on the pancreas and the kidneys. In the pancreas, it appears that fetuin-A serves to increase inflammatory agents through interaction with pancreatic adipose cells, and beta cells. The increased inflammation in turn increases the number of immune cells within the organ, and increases the rate of disease progression. Insulin resistance is a possible result of this inflammation and immune infiltration.

Fetuin-A Changes How Adipose Functions within the Kidneys

Within the kidneys fetuin-A changes how adipose functions. Typically, adipose is protective in the kidney. When fetuin-A is introduced to the adipose tissue within the kidney, however, it initiates inflammatory processes that inhibit renal function. These findings are related to other findings of the proinflammatory effects the hepatokine has on arterial vasculature,³ which is a possible mechanism for the common concomitant finding of atherosclerosis and hypertension in fatty liver disease.

Sources

1. Gerst F. et al. (2017): Metabolic crosstalk between fatty pancreas and fatty liver: effects on local inflammation and insulin secretion. Diabetologia, DOI: 10.1038/s41598-017-02210-4
2. Meex RCR, Watt MJ. Hepatokines: linking nonalcoholic fatty liver disease and insulin resistance. Nat Rev Endocrinol. 2017;13(9):509-520.
3. Siegel-axel DI, Ullrich S, Stefan N, et al. Fetuin-A influences vascular cell growth and production of proinflammatory and angiogenic proteins by human perivascular fat cells. Diabetologia. 2014;57(5):1057-66.

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Node Smith, ND, is a naturopathic physician in Portland, OR and associate editor for NDNR. He has been instrumental in maintaining a firm connection to the philosophy and heritage of naturopathic medicine among the next generation of docs. He helped found the first multi-generational experiential retreat, which brings elders, alumni, and students together for a weekend camp-out where naturopathic medicine and medical philosophy are experienced in nature. Four years ago he helped found the non-profit, Association for Naturopathic ReVitalization (ANR), for which he serves as the board chairman. ANR has a mission to inspire health practitioners to embody the naturopathic principles through experiential education. Node also has a firm belief that the next era of naturopathic medicine will see a resurgence of in-patient facilities which use fasting, earthing, hydrotherapy and homeopathy to bring people back from chronic diseases of modern living; he is involved in numerous conversations and projects to bring about this vision.