Should nonalcoholic fatty liver disease be regarded as a hepatic illness only?

role in the disease development and progression.Our current knowledge of the natural history of NAFLD can be summarized as follows: elevated body mass index (BMI) plays a key role; simple steatosis NAFL (Fatty liver, FL) does not generally progress to Non-Alcoholic SteatoHepatitis (NASH); patients with NASH progress, in relatively many cases, to cirrhosis; older age and advanced fibrosis are risk factors for hepatocellular carcinoma (HCC) in NASH; up to a third of patients develop liver-related morbidity or mortality.It is extremely important that physicians diagnose NASH accurately and perform appropriate treatments, because it represents an illness mirroring a systemic process, and an adjunctive cardiovascular disease (CVD) risk [1] .A great deal of research highlight the need for surrogate serum markers for diagnosing NASH.Among them, serum cytokeratin 18 has captured certain interest [2] . COULD NAFLD BE CONSIDERED A FURTHER EXPRESSION OF METABOLIC SYNDROME?NAFLD and NASH are conditions gaining increasing recognition, obesity being (mainly of high grade) one of the more important risk factors.But, do other aspects of metabolic syndrome (MS) play a role?To answer this question, a prospective study was conducted in 127 consecutive obese patients (62% female, mean age 40 ± 11 years, mean BMI 42 ± 6 kg/m 2 ) undergoing gastric bypass over a 20-month period.The report highlighted that arterial hypertension was present in 52 patients (41%) and type 2 diabetes mellitus (DM) in 18 (14%).However, NAFLD was confirmed in 80 patients (63%).Of them, 47 (37%) had FL, and 33 (26%) had NASH.Cirrhosis was found in 2 patients corresponding to 1.6% of the total population.For multivariate analysis, elevated HOMA independently predicted only NASH, (OR 4.18, 95% Confidence Interval, CI, 1.39-12.49).That NAFLD was frequently found, it is easy to deduce that the NAFLD presence coupled with obesity (visceral) and hypertension could be used as criteria to label the patients with MS [3] .