Effects of stressogenic factors on the course of metabolic-associated fatty liver disease. Review

Abstract

Metabolic‑associated fatty liver disease (MAFLD) is one of the most widespread diseases worldwide, including Ukraine. The complex pathophysiological MAFLD mechanisms include the disturbances of various processes (insulin resistance, lipotoxicity, pro‑inflammatory activation, changes in intestinal microbiota (IM), etc.). MAFLD is closely associated with the mental disorders, and they potentiate the course of each other. Stress induces both behavioral and biological reactions, which activate all the hypothalamic–pituitary–adrenal axis, thus resulting in the rise in the levels of cortisol and proinflammatory biomarkers that may be involved in the MAFLD development. There is a lack of data related to the effects of the stressogenic factors of the wartime and postwar state on the formation and progression of MAFLD. Knowledge about the role of chronic stress biomarkers (dehydroepiandrosterone, prolactin, brain neurotropic factor (BDNF)) in the MAFLD pathogenesis is insufficient. The literature data regarding changes in the qualitative and quantitative composition of the intestinal microbiota at the level of the main phyla in MAFLD patients are contradictory. The dynamics of intestinal microbiota under the influence of stress factors of war and post‑war times is not investigated. Complex determination of the degree of violation of the intestinal epithelial barrier integrity, the state of the IM, the level of stress hormones and pro‑inflammatory factors in patients with MAFLD in the stressful conditions of war and post‑war state will make it possible to clarify the pathophysiological links of MAFLD formation and progression and to work out pathogenetically based prophylactic and therapeutic interventions to inhibit the development of inflammation and fibrosis processes in liver tissue in MAFLD patients by means of correction of the microbiota and modification of the stress factors of the war and post‑war state. Moreover, it will enable investigations of the effects of the developed therapy on the clinical manifestations, metabolic profile, IM composition, inflammation, and the level of neurotropic hormones in MAFLD patients. Thus, scientific research of the effects of stressogenic factors on the course of metabolic‑associated fatty liver disease and determination of its pathogenetic mechanisms is relevant and appropriate.