Fatty liver, inflamed blood and calcified coronary arteries: Lessons and uncertainties from the multiethnic study of atherosclerosis -commentary on the study of Al Rifai et al.

Abstract

Obesity is a public health concern associated with comorbidities like dyslipidemia, type 2 diabetes mellitus, systemic hypertension, obstructive sleep apnea, a low-grade pro inflammatory state and non-alcoholic fatty liver disease (NAFLD) [1]. A recent survey from the US National Health and Nutrition Examination (NHANES) show that 34.9% of adults were obese between 2011 and 2012 [2]. This same survey shows that obesity starts early in younger ages: 8.1% of infants and toddlers had an elevated weight for their length and 16.9% of 2e19 years old were indeed obese [2]. Obesity is the major risk factor for the development of NAFLD. NAFLD is defined by the accumulation of liver fat >5% per liver weight, in the presence of <20 g/day for women and <30 g/day for men of daily alcohol intake, with exclusion of other liver diseases [3]. The spectrum of NAFLD includes not only steatosis, but steatohepatitisNASH, liver fibrosis, cirrhosis and hepatocarcinoma. NAFLD is seen in 20e30% of the adult population [4]. Fortunately the other more severe forms are not so frequent 1e2% of the cases. In our own cohort of more than 6000 asymptomatic Brazilian healthy individuals the prevalence of steatosis, a component of the