Nonalcoholic Fatty Liver Disease

Pouneh S. Mofrad, MD, Arun J. Sanyal, MD


April 16, 2003

In This Article

Risk Factors Associated With NAFLD

The most common risk factor associated with NAFLD is the presence of the metabolic syndrome. The metabolic syndrome is defined by the presence of 3 or more of the following criteria ( Table 2 )[15]: (1) increased waist circumference, (2) hypertriglyceridemia, (3) hypertension, (4) high fasting glucose, and (5) a low high-density lipoprotein (HDL) level. NAFLD is now recognized to be the hepatic manifestation of the metabolic syndrome. Given the fact that approximately 47 million individuals in the United States have the metabolic syndrome,[16] NAFLD represents a major health concern. Insulin resistance is the common pathophysiologic denominator that links all of the various components of the metabolic syndrome.

Of all of the individual clinical components of the metabolic syndrome, obesity has the strongest association with NAFLD. Obesity is defined as a body mass index (BMI) > 30 kg/m2.[17] The more obese the patient, the higher the risk of having a fatty liver. Thirty percent of patients who are obese have fatty liver, and up to 80% of morbidly obese patients (BMI > 35) have NAFLD.[18,19] Regardless of BMI, patients with truncal obesity are at greater risk of fatty liver disease. Other risk factors associated with NAFLD include type 2 diabetes, total parenteral nutrition, jejunal-ileal bypass operations for weight loss, and use of certain medications, including calcium-channel blockers and amiodarone ( Table 3 ).