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Dangerous Liaisons: The Metabolic Syndrome and Nonalcoholic Fatty Liver Disease

Elizabeth E. Powell, MBBS, PhD; Julie R. Jonsson, BSc, PhD; and Andrew D. Clouston, MBBS, PhD
[+] Article, Author, and Disclosure Information

From The University of Queensland and Princess Alexandra Hospital, Brisbane, Queensland 4102, Australia.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Elizabeth E. Powell, MBBS, PhD, Princess Alexandra Hospital, Ipswich Road, Brisbane, Queensland 4102, Australia; e-mail, Elizabeth_Powell@health.qld.gov.au.

Current Author Addresses: Dr. Powell: Princess Alexandra Hospital, Ipswich Road, Brisbane, Queensland 4102, Australia.

Dr. Jonsson: School of Medicine, The University of Queensland, Princess Alexandra Hospital, Ipswich Road, Brisbane, Queensland 4102, Australia.

Dr. Clouston: Histopath Pathology, P.O. Box 258, Strathfield, Sydney, New South Wales 2135, Australia.

Ann Intern Med. 2005;143(10):753-754. doi:10.7326/0003-4819-143-10-200511150-00015
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Nonalcoholic fatty liver disease (NAFLD) is an underrecognized manifestation of the metabolic syndrome. The term refers to a spectrum of fatty liver disease that occurs in the absence of significant alcohol consumption. At the “benign” end of the spectrum, most patients with NAFLD have fatty liver alone (simple steatosis). Only a small proportion (approximately 10%) also have features of liver cell injury or fibrosis, referred to as nonalcoholic steatohepatitis(NASH). This distinction between simple steatosis and NASH is important because the natural history of these categories differs substantially. Patients with simple steatosis usually have a benign prognosis from the point of view of liver disease (14). In contrast, up to 20% of patients with NASH may ultimately develop advanced liver disease (1, 35). The prognosis of NASH-related cirrhosis is poor: It results in liver failure or liver-related death in approximately one third of cases (67). Hepatocellular cancer is also a recently recognized complication of NASH-related cirrhosis (6, 8).

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