INTRODUCTION: LIVER NECROSIS VERSUS FATTY LIVER AND CIRRHOSIS

It is, of course, a great pleasure to write the introduction to this monograph based on the Conference on “Nutritional Factors and Liver Diseases,’’ which it has been my privilege to plan and to organize. The concepts and intentions which have guided this endeavor can be outlined as follows. Within the limitations of a two-day meeting and the following collection of papers presented, an attempt has been made to assemble a very broad spectrum of our present knowledge and of all current trends in research on nutritional liver disease, to put before you a real “symposium.” What appears more important, however, is that an effort has been made to put our various pieces of knowledge together in such a way as to form a clearer picture out of the rather chaotic development which this field has undergone. This may permit us to visualize and to understand possible relations between heretofore isolated areas; to clarify, a t least in part, some of the complex aspects of this field, which seemingly have been lacking integration so far. To achieve this purpose, several heterogeneous fields had to be brought together and connected in a coordinated fashion, the two most important ones being biochemical research in experimental animals on one side and clinical and pathological research on humans suffering from dietary liver disease on the other. Workers not only from various scientific fields but also from diiferent continents had to be brought together since the investigation of experimental dietary liver diseases has advanced most inNorth America and in Europe, whereas work in human nutritional liver injury has by necessity been carried out more intensely in Latin America, Asia, and especially in Africa, where Cecily Williams made her classical observations on kwashiorkor in 1933.’ Our appreciation is extended to all the workers from abroad who have contributed so effectively to the meeting and to this volume. The guiding consideration in the arrangement of the following material is based on the results of animal experimentation. It is quite certain that, in experimental animals, two completely different deficiency syndromes can be distinguished clearly. These are fatty liver and cirrhosis on the one hand, and acute (massive) liver necrosis, preferably called necrotic liver degeneration,* on the other. These two disease entities can be produced separately and even occupy a mutually antagonistic position in response to various dietary factors which are protective (see below). According to this clear-cut separation, the conference program and this monograph are separated into two main