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Ayse L. Mindikoglu [1; 2] and Antone R. Opekun [2; 3] and Sood K. Gagan [1] and Sridevi Devaraj [4]

Academic Editor: Kazuhiko Uchiyama

1, Michael E. DeBakey Department of Surgery, Division of Abdominal Transplantation, Baylor College of Medicine, Houston, TX, USA, bcm.edu

2, Department of Medicine, Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, TX, USA, bcm.edu

3, Department of Pediatrics, Division of Gastroenterology, Nutrition and Hepatology, Baylor College of Medicine, Houston, TX, USA, bcm.edu

4, Clinical Chemistry and Point of Care Technology, Texas Children’s Hospital and Health Centers, Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX, USA, bcm.edu

Received Jun 18, 2017; Revised Oct 1, 2017; Accepted Oct 12, 2017

This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

1. Global Impact of Obesity, Metabolic Syndrome, Nonalcoholic Fatty Liver Disease, and Hepatocellular Carcinoma

In 2014, the World Health Organization estimated that there were more than 1.9 billion adult overweight people of whom more than 600 million were obese [1]. More than 115 million people are estimated to have obesity-associated diseases (e.g., cardiovascular disease, stroke, diabetes, dyslipidemia, obstructive sleep apnea, metabolic syndrome, and breast, colon, and liver cancers) [1, 2]. A prospective, 16-year study of 900,053 US obese adults showed that subjects with a body mass index (BMI) ≥ 40 kg/m2 had 52% to 62% higher death rate from cancers compared to those with normal weight [3]. Obesity and metabolic syndrome are strong risk factors for nonalcoholic fatty liver disease (NAFLD), a chronic liver disease that can result in cirrhosis and liver cancer [4–6]. To compound this crisis, between 1960 and 2010, the obesity in adults in the US increased from 13% to 36% [7], which foretells of increasing significance. Aside from the negative health consequences, like liver disease and diabetes, the socioeconomic impact of these sequelae is profound [8]. The ramifications are far-reaching, and better approaches to addressing NAFLD are needed.

The Third National Health and Nutrition Examination Survey conducted between 1988 and 1994 reported that ~20% of the U.S. population had NAFLD [9]. A subsequent study showed a nearly 3-fold increase in NAFLD prevalence between 2003 and 2011...

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