NASH and Nutritional Therapy

Fatty liver disease including nonalcoholic steatohepatitis (NASH) involves the ac- mulation of triglycerides in hepatocytes with necrosisin?ammationand often ?b- sis with progression to cirrhosis. The two-hit model summarizes the important early metabolic events leading to hepatocellular necrosis in NASH. In these proceedings we present various new ?ndings and a review of NASH. The liver has an important role in nutritional homeostasis and liver diseases lead to abnormalities in nutrient metabolism and to subsequent malnutritionespecially in patients with liver cirr- sis. Protein-energy malnutrition (PEM) is a common ?nding in cirrhotic patients; it may be present in 20% of patients with well-compensated disease and in more than 60% of patients with severe liver insuf?ciency. Thereforespecial attention is required in the management of those patients; proper nutritional assessment and support for cirrhotic patients is essential. This volume also includes new ?ndings on the nut- tional aspects of the treatment of liver cirrhosis which we hope will contribute to a better understanding of NASH and nutritional treatment. We thank Otsuka Pharmaceutical Co. Ltd. for their continuing support. Organizing Committee of the Yamaguchi Symposium on Liver Disease Kiwamu OkitaM. D. Yamaguchi UniversityUbe Masamichi KojiroM. D. Kurume UniversityKurume Masao OmataM. D. The University of TokyoTokyo Norio HayashiM. D. Osaka UniversityOsaka Takeshi OkanoueM. D. Kyoto Prefectural University of MedicineKyoto Secretary General Isao SakaidaM. D. Yamaguchi UniversityUbe V Table of Contents Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . V List of Participants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . IX Nonalcoholic Fatty Liver (NAFL): Overview S. H. CaldwellA. Al-OsaimiC. ChangC. DavisE. E.