Non-alcoholic fatty liver disease with and without metabolic syndrome: Different long-term outcomes

Background. Non-alcoholic fatty liver disease (NAFLD) and metabolic syndrome (MetS) are both shown to increase the risk of cardiovascular diseases and type 2 diabetes. However, there is a great overlap between these two diseases. The present study was aimed to examine the cardiovascular and metabolic prognosis of non-alcoholic fatty liver disease with and without metabolic syndrome. Methods. Middle-aged subjects (n = 958) were divided into four subgroups, those with NAFLD and MetS, those with NAFLD or MetS, and healthy controls. The baseline characteristics of the subgroups were analyzed. The follow-up time for cardiovascular events was about 16 years. After approximately 21 years the cardiac ultrasound and laboratory parameters were re-analyzed and new type 2 diabetes cases were recorded. Results. Those with both diseases were at the greatest risk for cardiovascular events (p < 0.001). Compared to healthy controls, only those with MetS, with or without NAFLD, were at increased risk for the development of type 2 diabetes (p < 0.001) and for an increase in left ventricular mass index (p = 0.001 and p = 0.005, respectively). The cardiovascular and metabolic risk in subjects with NAFLD only was quite similar to that in healthy controls. The I148M variant of the patatin-like phospholipase domain-containing 3 gene (PNPLA3 polymorphism) was most present in those with NAFLD only (p = 0.008). Conclusions. NAFLD with MetS implies a considerable risk for cardiovascular diseases, type 2 diabetes and the increase of left ventricular mass index whereas NAFLD without MetS does not. (C) 2016 Elsevier Inc. All rights reserved.