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(Arteriosclerosis, Thrombosis, and Vascular Biology. 2008;28:27.)
© 2008 American Heart Association, Inc.

Brief Reviews

Fatty Liver

A Novel Component of the Metabolic Syndrome

Anna Kotronen; Hannele Yki-Järvinen

From the Department of Medicine, Division of Diabetes (A.K., H.Y.-J.), University of Helsinki, and Minerva Medical Research Institute (A.K.), Helsinki, Finland.

Correspondence to Hannele Yki-Järvinen, MD, FRCP, Department of Medicine, Division of Diabetes, University of Helsinki, Finland, P.O. Box 700, room C426B, FIN - 00029 HUCH, Helsinki, Finland. E-mail ykijarvi{at}cc.helsinki.fi

Series Editor: Marja-Riitta Taskinen
Metabolic Syndrome and Atherosclerosis
ATVB In Focus

Previous Brief Reviews in this Series:

•Gustafson B, Hammarstedt A, Andersson CX, and Smith U. Inflamed adipose tissue: a culprit underlying the metabolic syndrome and atherosclerosis. Arteroscler Thromb Vasc Biol. 2007;27:2276–2283.

Although the epidemic of obesity has been accompanied by an increase in the prevalence of the metabolic syndrome, not all obese develop the syndrome and even lean individuals can be insulin resistant. Both lean and obese insulin resistant individuals have an excess of fat in the liver which is not attributable to alcohol or other known causes of liver disease, a condition defined as nonalcoholic fatty liver disease (NAFLD) by gastroenterologists. The fatty liver is insulin resistant. Liver fat is highly significantly and linearly correlated with all components of the metabolic syndrome independent of obesity. Overproduction of glucose, VLDL, CRP, and coagulation factors by the fatty liver could contribute to the excess risk of cardiovascular disease associated with the metabolic syndrome and NAFLD. Both of the latter conditions also increase the risk of type 2 diabetes and advanced liver disease. The reason why some deposit fat in the liver whereas others do not is poorly understood. Individuals with a fatty liver are more likely to have excess intraabdominal fat and inflammatory changes in adipose tissue. Intervention studies have shown that liver fat can be decreased by weight loss, PPAR agonists, and insulin therapy.

Fat accumulation in the liver characterizes subjects who develop the metabolic syndrome. Liver fat also predicts, independent of obesity, the increased risk of type 2 diabetes, CVD, and liver disease, which accompany the metabolic syndrome.

Key Words: liver fat • metabolic syndrome • nonalcoholic liver disease

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