Effect of cofactors on NAFLD/NASH and MAFLD - a paradigm illustrating the pathomechanics of organ dysfunction

Amedeo Lonardo, Ashwani K. Singal, Natalia Osna, Kusum K. Kharbanda

Research output: Contribution to journalArticlepeer-review

25 Scopus citations


Primary nonalcoholic fatty liver disease (NAFLD) is bi-directionally associated with the metabolic syndrome and its constitutive features (“factors”: impaired glucose disposal, visceral obesity, arterial hypertension, and dyslipidemia). Secondary NAFLD occurs due to endocrinologic disturbances or other cofactors. This nosography tends to be outdated by the novel definition of metabolic associated fatty liver disease (MAFLD). Irrespective of nomenclature, this condition exhibits a remarkable pathogenic heterogeneity with unpredictable clinical outcomes which are heavily influenced by liver histology changes. Genetics and epigenetics, lifestyle habits [including diet and physical (in)activity] and immunity/infection appear to be major cofactors that modulate NAFLD/MAFLD outcomes, including organ dysfunction owing to liver cirrhosis and hepatocellular carcinoma, type 2 diabetes, chronic kidney disease, heart failure, and sarcopenia. The identification of cofactors for organ dysfunction that may help understand disease heterogeneity and reliably support inherently personalized medicine approaches is a research priority, thus paving the way for innovative treatment strategies.

Original languageEnglish (US)
Article number12
JournalMetabolism and Target Organ Damage
Issue number3
StatePublished - Sep 2022


  • Alcohol
  • HBV
  • HCC
  • HCV
  • HIV
  • NASH
  • diet
  • immunity
  • infection
  • maternal obesity
  • metabolic syndrome
  • microbiota
  • personalized medicine
  • physical activity
  • sex differences

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism


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