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Non-alcoholic fatty liver disease and cardiovascular disease

2012; Elsevier BV; Volume: 224; Issue: 2 Linguagem: Inglês

10.1016/j.atherosclerosis.2012.07.018

1879-1484

Raúl D. Santos, Stefan Agewall,

Alcohol Consumption and Health Effects

Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in the general population and is present when fatty infiltration affects >5% of hepatocytes, in the presence of <20 g alcohol consumption per day, without evidence of other causes of liver disease [ 1 Preiss D. Sattar N. Non-alcoholic fatty liver disease: an overview of prevalence, diagnosis, pathogenesis and treatment considerations. Clin Sci (Lond). 2008; 115: 141-150 Crossref PubMed Scopus (242) Google Scholar , 2 Ahmed M.H. Abu E.O. Byrne C.D. Non-alcoholic fatty liver disease (nafld): new challenge for general practitioners and important burden for health authorities?. Prim Care Diabetes. 2010; 4: 129-137 Abstract Full Text Full Text PDF PubMed Scopus (51) Google Scholar ]. Non-alcoholic steatohepatitis (NASH) represents the more advanced stages of this disease. Due to its increasing incidence and frequent association with excess body weight and the metabolic syndrome, NAFLD has become a condition of interest not only to hepatologists but also to cardiologists and endocrinologists [ 1 Preiss D. Sattar N. Non-alcoholic fatty liver disease: an overview of prevalence, diagnosis, pathogenesis and treatment considerations. Clin Sci (Lond). 2008; 115: 141-150 Crossref PubMed Scopus (242) Google Scholar , 2 Ahmed M.H. Abu E.O. Byrne C.D. Non-alcoholic fatty liver disease (nafld): new challenge for general practitioners and important burden for health authorities?. Prim Care Diabetes. 2010; 4: 129-137 Abstract Full Text Full Text PDF PubMed Scopus (51) Google Scholar ]. NAFLD is a syndrome with a spectrum ranging from simple steatosis (liver fat accumulation) that can progress to liver inflammation (steatohepatitis or NASH), liver fibrosis, cirrhosis and possibly hepatic cell carcinoma [ 3 Day C.P. Natural history of NAFLD: remarkably benign in the absence of cirrhosis. Gastroenterology. 2005; 129: 375-378 Abstract Full Text Full Text PDF PubMed Scopus (126) Google Scholar , 4 Fassio E. Alvarez E. Dominguez N. Landeira G. Longo C. Natural history of non-alcoholic steatohepatitis: a longitudinal study of repeat liver biopsies. Hepatology. 2004; 40: 820-826 Crossref PubMed Scopus (419) Google Scholar ]. In our own cohort of 2238 young, healthy subjects consuming less than 20 g of alcohol per day, the prevalence of steatosis detected non-quantitatively by hepatic ultrasound was around one third [ [5] Ndumele C.E. Nasir K. Conceiçao R.D. Carvalho J.A. Blumenthal R.S. Santos R.D. Hepatic steatosis, obesity, and the metabolic syndrome are independently and additively associated with increased systemic inflammation. Arterioscler Thromb Vasc Biol. 2011; 31: 1927-1932 Crossref PubMed Scopus (114) Google Scholar ]. This prevalence of NAFLD raises in patients with type II diabetes mellitus and with increasing body weight: 25%, 65–75%, and 85–90% respectively in those with body mass index (BMI) < 30 kg/m2, >30 kg/m2, and >35 kg/m2 [ 3 Day C.P. Natural history of NAFLD: remarkably benign in the absence of cirrhosis. Gastroenterology. 2005; 129: 375-378 Abstract Full Text Full Text PDF PubMed Scopus (126) Google Scholar , 4 Fassio E. Alvarez E. Dominguez N. Landeira G. Longo C. Natural history of non-alcoholic steatohepatitis: a longitudinal study of repeat liver biopsies. Hepatology. 2004; 40: 820-826 Crossref PubMed Scopus (419) Google Scholar ], however most cases are unrecognized since the subjects often are asymptomatic. The prevalence of more advanced and serious NASH, generally detected by concomitant liver enzyme elevation in addition to imaging, is around 15–20% in those with BMI >30 kg/m2. From the hepatologist's point of view 2–3% of those presenting steatosis will progress to liver cirrhosis after 12–15 years [ 1 Preiss D. Sattar N. Non-alcoholic fatty liver disease: an overview of prevalence, diagnosis, pathogenesis and treatment considerations. Clin Sci (Lond). 2008; 115: 141-150 Crossref PubMed Scopus (242) Google Scholar , 3 Day C.P. Natural history of NAFLD: remarkably benign in the absence of cirrhosis. Gastroenterology. 2005; 129: 375-378 Abstract Full Text Full Text PDF PubMed Scopus (126) Google Scholar , 4 Fassio E. Alvarez E. Dominguez N. Landeira G. Longo C. Natural history of non-alcoholic steatohepatitis: a longitudinal study of repeat liver biopsies. Hepatology. 2004; 40: 820-826 Crossref PubMed Scopus (419) Google Scholar ]. More worrisome, the chance of cirrhosis is around 12% after 8 years in those with NASH. From the point of view of the endocrinologist, in addition to the classic findings of concomitant obesity and atherogenic dyslipidemia, NAFLD may be associated with an independent risk of type 2 diabetes onset [ [6] Carvalho J.A. Barengo N.C. Tuomilehto J. Conceição R.D. Santos R.D. The finnish diabetes risk score (FINDRISC) as a screening tool for hepatic steatosis. Ann Med. 2011; 43: 487-494 Crossref PubMed Scopus (16) Google Scholar ] since hepatic insulin resistance is one of the main components of the pathophysiology of this disease. Liver fat content is associated with increased carotid atherosclerosis in a Chinese middle-aged and elderly population: The Shanghai Changfeng studyAtherosclerosisVol. 224Issue 2PreviewNonalcoholic fatty liver disease is closely associated with metabolic syndrome and cardiovascular disease (CVD). We investigated whether the liver fat content (LFC) is independently associated with carotid artery intima-media thickness (CIMT) and evaluated the contribution of the LFC to the increased CIMT. Full-Text PDF