Metabolic Syndrome and NASH

In the last few years several clinical and epidemiological studies have convincingly associated nonalcoholic fatty liver with the metabolic syndrome, having insulin resistance as the pivotal pathogenic factor. Obesity, type 2 diabetes mellitus, dyslipidemia and hypertension differently contribute to an increased risk of liver disease, and to disease progression. The presence of multiple metabolic abnormalities is associated with the severity of liver disease, namely with the fibrosis characterizing nonalcoholic steatohepatitis, with cryptogenic cirrhosis and finally with hepatocellular carcinoma. These subjects have a high risk of cardiovascular morbidity and mortality, mediated by early atherosclerosis. This evidence has precise therapeutic implications: only a behavior approach to lifestyle correction will simultaneously address all the alterations characterizing the metabolic syndrome, including metabolic liver disease.