Metabolic syndrome and related liver diseases

Abstract

The metabolic syndrome is often accompanied by liver disease, specifically nonalcoholic fatty liver disease (NAFLD). NAFLD is a clinicopathological entity characterized by accumulation of fat in the liver in the setting of minimal to no alcohol intake. It represents a spectrum of liver disease ranging from steatosis to advanced fibrosis or cirrhosis and can lead to hepatocellular carcinoma. The causes of NAFLD are multifactorial and include genetic predisposition and environmental factors including overnutrition. NAFLD is not a defining characteristic of the metabolic syndrome, but these conditions frequently coexist, especially in the setting of obesity. The prevalence of NAFLD in pediatrics has not been clearly determined, but this is considered the most common pediatric liver disease. An important challenge is that NAFLD is typically asymptomatic and is usually not diagnosed unless the clinician specifically evaluates the patient for it. The diagnosis of NAFLD is established through a liver biopsy. There are pathogenetic links between NAFLD and the metabolic syndrome, but the precise pathogeneses of these conditions remain to be fully elucidated. The effects of NAFLD on the natural history of the metabolic syndrome, and vice versa, are not known. However, it is possible that these conditions may exacerbate one another. Further research is needed to answer important questions regarding pediatric NAFLD and its relationship to the metabolic syndrome. What is clear is that given the high prevalence of overweight and obesity, clinicians need to be well informed about the risk of liver disease in the patient with metabolic syndrome.