6 Non-Alcoholic Fatty Liver Disease (Nafld) Is Associated With Higher Overall Mortality and Liver Related Mortality

Risk of severe liver disease in nonalcoholic fatty liver disease with normal aminotransferase levels: A role for insulin resistance and diabetes

“…These data are supported by the analysis of NAFLD-related mortality at a population-based level. Data from two registry-based cohorts indicated that patients with NAFLD had a 2.6-fold increased mortality compared to the general population, 31,32 and these data were confirmed by Adams et al, 6 who analyzed the natural history of patients with NAFLD. In patients with NAFLD there was definitely an excess mortality risk over the age-matched and sex-matched general population, and the risk increased with longer follow-up.…”

“…6 This risk includes both cardiovascular and liver-related events, as shown in cohort studies with long follow-up. 7,13,[30][31][32][33]34 In conclusion, our data indicate that more than half of NAFLD patients with persistently normal ALT have a potentially progressive liver disease. In the absence of biopsy or of an adequate score able to identify subjects at risk, these patients could miss careful follow-up and might be scarcely motivated toward lifestyle modifications that are potentially able to cure their liver disease and the extrahepatic manifestations of the metabolic syndrome.…”

Nonalcoholic fatty liver disease and nonalcoholic steatohepatitis: Selected practical issues in their evaluation and management

“…The patients with NAFLD have very high prevalence of cardiovascular risk factors and atherosclerosis and high incidence of cardiovascular morbidity and mortality 43, 113, 114. Over the last decade, numerous studies have demonstrated that patients with NAFLD are enriched with classic cardiovascular risk factors such as obesity, insulin resistance and type2 diabetes, dyslipidemia, and the metabolic syndrome 115-117.…”

“…Cross-sectional studies have also shown increased prevalence of premature atheroma formation,120 carotid artery intima media thickness (surrogate for atherosclerosis),121, 122 vulnerable coronary plaques, 123 increased mediastinal fat and abnormal left ventricular energy metabolism 124. Recently it has been suggested that NAFLD poses cardiovascular risk above and beyond that is conferred by the presence of the metabolic syndrome 43, 113, 114, 125. In a nested case-control, prospective study, Targher et al have shown that NAFLD in diabetic individuals is associated with moderately increased risk of incident cardiovascular disease even after adjusting for classic risk factors, glycemic control and the metabolic syndrome 125.…”

“…In a nested case-control, prospective study, Targher et al have shown that NAFLD in diabetic individuals is associated with moderately increased risk of incident cardiovascular disease even after adjusting for classic risk factors, glycemic control and the metabolic syndrome 125. Most importantly, several longitudinal studies have shown that cardiovascular disease is much more common than liver disease as a cause of death in patients with NAFLD 43, 113, 114. In a longitudinal study consisting of 420 Olmsted county residents with NAFLD, Adams et al113 have shown that ischemic heart disease accounts of 25% of deaths, compared to liver disease accounting for 13% of deaths.…”