Metabolic Syndrome, Diabetes and Nonalcoholic Steatohepatitis

The epidemic of obesity is driving an epidemic of associated complications, including principally type 2 diabetes. Obesity induces an insulin‐resistant and proinflammatory state with detrimental effects on metabolism, cardiovascular and liver function. Central obesity is considered the cornerstone of the metabolic syndrome, focusing attention on the endocrine role of adipocytes and the chronic inflammatory response associated with adipose tissue accumulation. Type 2 diabetes results from an interaction between obesity‐related insulin resistance and progressive β cell failure in those who are genetically predisposed. Nonalcoholic fatty liver disease (NAFLD) is an associated condition that describes a broad spectrum of hepatic abnormalities which extends from simple steatosis to nonalcoholic steatohepatitis (NASH). NAFLD is increasingly considered a manifestation of the metabolic syndrome, pathogenetically linked to obesity and insulin resistance. NASH can progress to cirrhosis, liver failure and hepatocellular cancer, posing a serious additional health risk in obesity. This chapter discusses the relationship between obesity, type 2 diabetes and NAFLD.