Management of fatty liver disease with the metabolic syndrome

Abstract

Non-alcoholic fatty liver disease (NAFLD) is the liver disease of this century, increasing in parallel with obesity, insulin resistance and the metabolic syndrome. NAFLD can be seen as a component of the metabolic syndrome, and as such, contributing as a risk factor for cardiovascular disease. In fact, these patients die more often from cardiovascular disease than from direct consequences of liver disease. In this review, we will summarize the data that link NAFLD as a central player in this dysmetabolism, as well as the evidence for appropriate therapy, in order to improve not only liver disease prognosis, but also the overall prognosis and risk of mortality, with particular focus on cardiovascular risk.

Keywords::

• cardiovascular risk
• insulin resistance
• management
• metabolic syndrome
• non-alcoholic fatty liver disease

Acknowledgments

We thank GA Michelotti for his excellent support in reviewing the article.

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Non-alcoholic fatty liver disease (NAFLD) and the metabolic syndrome (MS) are two highly prevalent conditions that promote each other and confer increased morbid mortality.

• The presence of the MS and its components, as well as insulin resistance (IR)/type 2 diabetes mellitus (T2DM), strongly associates with NAFLD development, severity and worse outcome.

• NAFLD also increases the risk of developing the MS and IR/T2DM.

• The main cause of death in patients with NAFLD is cardiovascular disease, followed by malignancies and liver disease.

• Treatment of patients with NAFLD should aim not only to improve liver-related prognosis, but also to manage the associated metabolic disturbances in order to decrease cardiovascular risk.

• All patients with NAFLD should have strong counseling about personalized lifestyle changes, with particular focus in diet and exercise, promoting weight loss when needed.

• NAFLD by itself should not be an indication to start anti-diabetics, lipid- and blood pressure-lowering drugs, but IR/T2DM, dyslipidemia and hypertension should be addressed aggressively in those patients.

• The only liver-specific treatment approved for NAFLD is vitamin E, which can be used in non-diabetics, non-cirrhotic patients with biopsy-proven non-alcoholic steatohepatitis, since those are the only patients with appropriate evidence of benefit.