Metabolic syndrome and non-alcoholic fatty liver disease

Authors: Marek Rác;  Ubomír Skladaný
Authors‘ workplace: Interná klinika, Fakultná nemocnica Nitra
Published in: Forum Diab 2023; 12(2): 68-74


Non-alcoholic fatty liver disease (NAFLD) represents the hepatic manifestation of the metabolic syndrome. The epidemiology mirrors the prevalence of obesity and DM2T. It represents the most common chronic liver disease. NAFLD is a general term that encompasses all grades and stages of the disease and refers to a population in which ≥ 5% of hepatocytes exhibit macrovesicular steatosis in the absence of a readily identified alternative cause of steatosis. Globally, the prevalence of NAFLD and NASH is increasing in parallel with the increase in the prevalence of diabetes and obesity. In the adult population, it is estimated to be 30%; the prevalence in the diabetic cohort is virtually ubiquitous. Fibrosis and the presence of steatohepatitis are the primary predictors of disease progression. Fibrosis progression is influenced by many factors such as the presence and severity of metabolic comorbidities, genomic profile and environmental factors. Cardiovascular events and nonhepatic neoplasia are the most common causes of mortality in NAFLD patients without advanced fibrosis; hepatic mortality predominates in patients with advanced fibrosis. The pathogenetic foundation is an imbalance between nutrient supply with inefficient utilization in conjunction with adipose tissue dysfunction. Systemic inflammation, stemming from dysfunctional adipose tissue, contributes to disease progression. Insulin resistance perpetuates the development of NAFLD and, in NASH, promotes disease progression. Patients with NAFLD should be screened for the presence of DM2T and vice versa. Patients with diabetes have a higher risk of NASH and advanced fibrosis, so noninvasive staging of fibrosis is an implicit imperative. Weight reduction improves hepatic steatosis, NASH, and liver fibrosis in a dose-dependent manner. Comprehensive treatment of metabolic comorbidities is best achieved using a multidisciplinary approach and interdisciplinary collaboration.


Adipose tissue – metabolic syndrome – non-alcoholic fatty liver disease – insulin resistance – diabetes mellitus – non-alcoholic steatohepatitis – systemic inflammation


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