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Review
. 2021 Jun:119:154770.
doi: 10.1016/j.metabol.2021.154770. Epub 2021 Apr 14.

Non-alcoholic fatty liver disease, insulin resistance, metabolic syndrome and their association with vascular risk

Emir Muzurović  1 , Dimitri P Mikhailidis  2 , Christos Mantzoros  3
Affiliations
Review

Non-alcoholic fatty liver disease, insulin resistance, metabolic syndrome and their association with vascular risk

Emir Muzurović et al. Metabolism. 2021 Jun.

Abstract

The prevalence of non-alcoholic fatty liver disease (NAFLD), one of the most common liver diseases, is rising. About 25% of adults worldwide are probably affected by NAFLD. Insulin resistance (IR) and fat accumulation in the liver are strongly related. The association between NAFLD, metabolic syndrome (MetS) and IR is established, but an independent impact of NAFLD on vascular risk and progression of cardiovascular (CV) disease (CVD) still needs to be confirmed. This narrative review considers the evidence regarding the link between NAFLD, IR and CVD risk. There is strong evidence for a "concomitantly rising incidence" of NAFLD, IR, MetS and CVD but there is no definitive evidence regarding whether NAFLD is, or is not, an independent and significant risk factor the development of CVD. There are also considerations that type 2 diabetes mellitus (T2DM) may be a common link between NAFLD/non-alcoholic steatohepatitis (NASH) and CVD. NAFLD may be associated with widespread abnormal peri-organ or intra-organ fat (APIFat) deposition (e.g. epicardial adipose tissue) which may further contribute to CV risk. It is clear that NAFLD patients have a greater CV risk (independent or not) which needs to be addressed in clinical practice.

Keywords: Diabetes mellitus; Insulin resistance; Metabolic syndrome; Non-alcoholic fatty liver disease; Treatment; Vascular risk.

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Conflict of interest statement

Declaration of competing interest EM has given talks or attended conferences sponsored by Novo Nordisk, SANOFI, AstraZeneca, SERVIER and Merck. DPM has given talks, acted as a consultant or attended conferences sponsored by Amgen, Novo Nordisk and Libytec. The article is based on a lecture given by DPM as part of the 18th Annual World Congress Insulin Resistance Diabetes & Cardiovascular Disease meeting, Los Angeles, USA, December 3–5, 2020. DPM received a fee from the organizers of the meeting; there was no specific pharmaceutical industry funding or any involvement in the content of the lecture or present review. CM reports grants, personal fees and other from Coherus Inc., grants, personal fees and other from Novo Nordisk, personal fees and non-financial support from Ansh, personal fees and non-financial support from Aegerion, personal fees and non-financial support from PES, personal fees and non-financial support from California Walnut Commission, personal fees from Genfit, personal fees from Intercept, personal fees from Regeneron, personal fees from CardioMetabolic Health Conference - The Metabolic Institute of America, personal fees from Amgen, outside the submitted work.

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