Beyond the liver in patients with non-alcoholic fatty liver disease (NAFLD)—cause for concern?

Non-alcoholic fatty liver disease (NAFLD) is a global public health problem and is the most common cause of chronic liver disease worldwide. The prevalence of NAFLD is approximately 30%, irrespective of ethnicity, and parallels the exponential rise of the obesity and diabetes epidemics. The active inflammatory and cell injury component of NAFLD, known as non-alcoholic steatohepatitis (NASH), increases the risk of liver-related mortality by 5 to 10 times; but this is largely dependent on the extent of fibrosis (1,2). Despite this, cardiovascular disease (CVD) and extra-hepatic malignancy remain the commonest causes of death in these cohorts. Therefore, non-surprisingly the last decade has seen the clinical focus switch from NAFLD as a solitary organ entity to a multi-systemic disease