Nonalcoholic fatty liver disease and metabolic syndrome

Authors: Marek Rác 1;  Ľubomír Skladaný 2
Authors‘ workplace: Hepatologická ambulancia, Interná klinika FN Nitra, VŠ ZaSP sv. Alžbety, Bratislava 1;  Hepatologické, gastroenterologické a transplantačné oddelenie, II. interná klinika SZU a FNsP F. D. Roosevelta, Banská Bystrica 2
Published in: Forum Diab 2018; 7(2): 109-116


Non-alcoholic fatty liver disease (NAFLD) and the metabolic syndrome are conditions with growing prevalence. The relationship between them is complex and bi-directional. The pathophysiological basis in both cases is insulin resistance. Diabesity is reaching the level of a global epidemic. It contributes to the rising prevalence of systemic diseases associated with obesity. Non-alcoholic fatty liver disease has become the most widespread chronic liver disease in developed countries and it is considered a hepatic manifestation of the metabolic syndrome. The spread and burden of the disease has been constantly growing and reaches epidemic levels, affecting 30% of the adult population. In a group of patients with the metabolic syndrome the prevalence of NAFLD is significantly higher compared with the general population. NAFLD is characterized by an increased amount of intrahepatic fat. It occurs in two basic forms. One is non-alcoholic steatosis (NAFL), the other is progressively developing non-alcoholic steatohepatitis (NASH). As opposed to NAFLD, NASH represents a subgroup with increased risk for the progression of fibrosis, cirrhosis or onset of HCC and it is considered to be linked with an increased incidence of cardiovascular events. Obesity and type 2 diabetes mellitus are among the risk factors for the NASH progression. The growing prevalence of NASH in the near future will bring an enormous cohort of our patients to the stage of advanced liver disease. If the effort to reverse the undesirable epidemiological trend fails, NASH will become the most common indication for liver transplantation in the coming decade. The ever increasing trend of development can be observed in the rising incidence of hepatocellular carcinoma in causal relation to NASH [1]. The comprehensive treatment of the metabolic syndrome components and, in future, a treatment aimed at affecting the key pathogenetic mechanisms might change the individual future of patients, as well as the global burden resulting from NASH.

Key words:

diabetes mellitus, insulin resistence, metabolic syndrome, non-alcoholic steatohepatitis, non-alcoholic fatty liver disease, obesity

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