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The increasing global prevalence of liver metabolic diseases associated with overweight, diabetes, high blood pressure and dyslipidemia has become a major public health problem. The spectrum of metabolic liver diseases - the nonalcoholic fatty liver disease (NAFLD) - parallels the prevalence of metabolic syndrome and is associated with the number of its components.1-3
NAFLD is characterized by excessive hepatic fat accumulation (steatosis) and it associates insulin resistance (IR) in the absence of secondary causes and in the absence of excessive alcohol intake (>30 g for men and >20 g for women).4-5 Patients who consume moderate amounts of alcohol may still have a predisposition towards NAFLD in the presence of metabolic risk factors. Steatosis is very common in developed countries (17-46%) and its prevalence is increasing with the body mass index: 67% with overweight and 94% with obesity.6-7
NAFLD could evolve to a more advanced condition [non-alcoholic steatohepatitis (NASH)] having different prognosis than isolated steatosis and a large spectrum of disease severity, including hepatic fibrosis, cirrhosis and hepatocellular carcinoma (HCC).
A recent study has assessed retrospectively a tertiary center cohort, and has shown that the 10-years comparative overall survival of patients with NAFLD was lower than that of patients with chronic hepatitis C (CHC), mainly explained by the fact that patients with NAFLD had older ages, and by the associated non-liverrelated deaths.8 NAFLD overall survival was lower than in chronic hepatitis B (CHB) and higher than in alcoholic liver diseases (ALD). It was known that cardiovascular disease has higher incidence and prevalence in patients with NAFLD than in matched controls9 and in a recent prognostic study, it was observed that cardiovascular disease is a more frequent cause of death than liver disease in patients with NAFLD versus CHC, even in subjects younger than 50 years.8 NAFLD is also associated with other extra-hepatic diseases as chronic kidney disease10 and non-liver cancers (i.e., colorectal cancer).11 A recent study highlighted age as being a key prognostic factor: patients with NAFLD who were 50 years of age or older had lower survivals than patients with CHC, mainly due to non-liver-related cancers, and cardiovascularrelated deaths, despite a lower number of liverrelated deaths.8
Clinical practice guidelines released by the European Associations for the Study of the Liver (EASL), of Diabetes (EASD) and...