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Extrahepatic complications of liver fat
WHY DOES LIVER FAT CONTRIBUTE TO CARDIO-
METABOLIC OUTCOMES?
Hannele Yki-Jar vinen
Department of Medicine, University of Helsinki,
Helsinki, Finland
Email: ykijarvi@cc.helsinki.fi
Take home messages
• Both ‘metabolic NAFLD’ and the features of IR/MetS increase the risk of CVD, even independent
of obesity.
• ‘Metabolic NAFLD’ and IR share a common pathophysiology, which may explain their link with
CVD.
• ‘Metabolic NAFLD’ may be even be a better predictor of CVD as it more directly measures abnormal
metabolism than the MetS.
• NAFLD patients with the PNPLA3 I148M polymorphism have steatosis but not the features of IR,
implying that steatosis and IR and the risk for CVD dissociate.
‘Metabolic NAFLD’, MetS and risk of CVD
The MetS represent a cluster of risk factors reflecting IR [1]. It is well established that features of
IR/MetS, such as fasting hyperglycemia, hyperinsulinemia, abdominal obesity, high triglycerides/low
HDL cholesterol and small dense LDL cholesterol predict CVD, independently of obesity. NAFLD,
diagnosed by liver enzymes, ultrasound or a liver biopsy, has also been shown in prospective studies to
predict CVD, even independently of obesity (Fig. 1).
Figure 1. NAFLD as an obesity/MetS independent predictor of CVD events/mortality.
56 Postgraduate Course Syllabus • Metabolic Liver Disease
WHY DOES LIVER FAT CONTRIBUTE TO CARDIO-
METABOLIC OUTCOMES?
Hannele Yki-Jar vinen
Department of Medicine, University of Helsinki,
Helsinki, Finland
Email: ykijarvi@cc.helsinki.fi
Take home messages
• Both ‘metabolic NAFLD’ and the features of IR/MetS increase the risk of CVD, even independent
of obesity.
• ‘Metabolic NAFLD’ and IR share a common pathophysiology, which may explain their link with
CVD.
• ‘Metabolic NAFLD’ may be even be a better predictor of CVD as it more directly measures abnormal
metabolism than the MetS.
• NAFLD patients with the PNPLA3 I148M polymorphism have steatosis but not the features of IR,
implying that steatosis and IR and the risk for CVD dissociate.
‘Metabolic NAFLD’, MetS and risk of CVD
The MetS represent a cluster of risk factors reflecting IR [1]. It is well established that features of
IR/MetS, such as fasting hyperglycemia, hyperinsulinemia, abdominal obesity, high triglycerides/low
HDL cholesterol and small dense LDL cholesterol predict CVD, independently of obesity. NAFLD,
diagnosed by liver enzymes, ultrasound or a liver biopsy, has also been shown in prospective studies to
predict CVD, even independently of obesity (Fig. 1).
Figure 1. NAFLD as an obesity/MetS independent predictor of CVD events/mortality.
56 Postgraduate Course Syllabus • Metabolic Liver Disease
