Non-alcoholic Fatty Liver Disease, Cardio-metabolic Syndrome and Hypertension: One Concept Fits Multi-systemic Presentations

Abstract

Metabolic syndrome (MetS) is a complex condition in which several interrelated risk factors for cardiovascular diseases (CVD) and type 2 diabetes mellitus (T2DM) co-exist. Clinically, MetS can be diagnosed if at least 3 of the following conditions are present: abdominal obesity, high blood pressure, high blood glucose, high serum triglycerides, and low serum high-density lipoprotein. 1) Excessive adiposity, insulin resistance, dysglycemia, hypertension and CVD have been traditionally treated as a separate disease. However, the association beween such diseases can be reasonably explained within the concept of MetS. 2) Non-alcoholic fatty liver disease or non-alcoholic steatohepatitis (NAFLD/NASH) is a hepatic manifestation of MetS. 3) In worldwide pandemic of obesity and T2DM, NAFLD/ NASH affects over 25% of general population including 10% of American children. 4) It has emerged as a major cause of chronic liver disease and now the second leading indication for liver transplantation in the United States. 5) Among the adiposity-based chronic organ dysfunctions, ectopic fat infiltration of the liver has particular significance because it is closely associated with increased CVD. 6) In the setting of obesity-related MetS, hepatic production of triglyceride and glucose is increased and hepatic clearance of low-density lipoprotein (LDL) cholesterol is decreased. The East Asian ethnicity appears to be particularly vulnerable to obesity-related metabolic derangement and CVD. 7)8) In this issue, the probable association between NAFLD/NASH and hypertension was presented in general population using national health checkup data. 9) Fatty liver index (FLI) was used as a surrogate marker of NAFLD/NASH, in which FLI was calculated with the formula including triglyceride, gamma-glutamyl transferase (GGT), waist circumference and body mass index. The authors concluded that higher FLI was associated with the increased risk of newly developed hypertension after 2 years. In detail, individuals with pre-existing hypertension, diabetes, cardiovascular diseases and on lipid-lowering medications at baseline were excluded. The endpoint of study was a diagnosis of hypertension at a later health checkup. In the higher FLI quartile, the percentage of male, systolic blood pressure, current smoker rate, and the amount of alcoholic consumption were significantly higher. Fasting blood glucose, total cholesterol, LDL-cholesterol and GGT were also significantly higher.

Evaluation of choroidal thickness in non-alcoholic fatty liver disease

“…This intricate relationship is explicable in the broader context of MetS. [21] Therefore, a group of experts have propounded the modi ed term of metabolic (dysfunction)-associated fatty liver disease (MAFLD) in order to highlight the metabolic aspect in this disease. [22] Nevertheless, the association between choroidal changes and NAFLD AND MetS components remains controversial.…”