Abstract
Metabolic syndrome (MS) is one of the most widely spread diseases in so-called developed countries that is closely linked to the occurrence of cardiovascular as well as other diseases. Abdominal obesity with excess visceral fat and the associated insulin resistance is the main feature.
Other main features include impaired glucose metabolism, dyslipidaemia, and arterial hypertension. Metabolic syndrome is closely related to hepatic steatosis that, in the majority of cases, is a benign and reversible liver injury.
Under certain circumstances, however, simple steatosis can be accompanied by an inflammatory component and the condition may progress to NASH (non-alcoholic steatohepatitis) and liver fibrosis, ultimately resulting in liver cirrhosis and hepatocellular carcinoma. In the English literature, these particular stages of liver disease (simple hepatic steatosis, steatohepatitis, fibrosis, and cirrhosis) are collectively referred to as NAFLD (non-alcoholic fatty liver disease).
While simple steatosis is not dangerous to the sufferer, NASH is the beginning of the development of cirrhosis. The aetiopathogenesis of NASH shares common features with that of insulin resistance and metabolic syndrome.
Although liver biopsy remains the gold standard of diagnosis, novel diagnostic procedures seem to be emerging that could distinguish simple steatosis from NASH in a non-invasive manner. The treatment involves lifestyle measures and drugs reducing insulin resistance, thus also used in the treatment of type 2 diabetes; in addition, a number of other drugs are also being tested.
So far, however, there is a lack of randomized, double-blind, placebo-controlled studies wherein the treatment outcome would be confirmed by histology. A number of issues still remain to be elucidated in both the aetiopathogenesis of NAFLD and NASH and in their diagnosis and treatment.