The non-alcoholic fatty liver disease (NAFLD) is a significantly increasing
cause of chronic liver disease which is strongly associated with obesity and insulin
resistance. Due to this association it is considered as the hepatic manifestation of the
metabolic syndrome. According to the emerging clinical and epidemiological data
patients with NAFLD have an increased morbidity and mortality of cardiovascular
diseases (CVD), type 2 diabetes mellitus, chronic kidney disease as well as
malignancies, beyond the liver-related mortality. A number of other less established
comorbidities can also manifest together with NAFLD, like colorectal cancer,
hypothyroidism, obstructive sleep apnea, polycystic ovarian syndrome and
osteoporosis.
The majority of the patients however, maybe asymptomatic and the diagnosis is made
only incidentally. Obesity, high body mass index (BMI), elevated transaminase levels
and/or hyperechogenic ultrasound form the basis for the diagnosis. About 20% of the
cases can progress to non-alcoholic steatohepatitis (NASH) and cirrhosis. Fibrosis,
however, can be initiated either in simple steatosis or in NASH i.e. due to the most
recent results, fibrosis progression is independent of the presence of NASH. In patients
with simple steatosis and no inflammation, the fibrosis progression is very slow. The
rapid progressors, however, can progress to cirrhosis within 2-6 years. In these patients,
hypertension and diabetes are usually also present. The presence and severity of
fibrosis on liver biopsy are the best indicators of long-term liver-related outcome in
patients with NAFLD. The most important step during diagnosis is risk stratification.
Once a patient with NAFLD develops cirrhosis, he has the same natural history as with
other etiologies. Patients with compensated cirrhosis have a 3-4% risk of mortality
annually.
Keywords: Cardiovascular diseases, Chronic kidney disease, Colorectal cancer,
Hypothyroidism, Non-alcoholic fatty liver disease, Non-alcoholic steatohepatitis,
Obstructive sleep apnea, Osteoporosis.
