Non-alcoholic fatty liver disease (NAFLD): A new mechanism for co-morbidities in chronic obstructive pulmonary disease (COPD)?

Background: Non-alcoholic fatty liver disease (NAFLD) is a growing health concernassociated with obesity and type 2 diabetes, and is prevalent in upto 25% of the general population. Current evidencedemonstrates a robust association between NAFLD and cardiovascular morbidity and mortality. Low grade inflammation, oxidative stress, reduced physical activity and metabolic syndrome that are common feature in COPD might participate to NAFLD occurrence but this has been poorly investigated. Methods: Noninvasive blood tests (SteatoTest, NashTest, and FibroTest) were used to evaluate steatosis, nonalcoholic steatohepatitis (NASH), and liver fibrosis in a prospective cohort of COPD patients. Results: Among the 111 COPD included (men, 77.5%; median age, 64 years; median BMI, 25.6 kg/m 2 ;Gold 1-2:74.8%; Gold 3-4:25.2%), the prevalence of steatosis (stages ≥S2), NASH (stages N1 or N2) and fibrosis (stages ≥F1) were respectively 41.4%, 36.9% and 61.3%. In univariate analysis, the different severities of NAFLD were significantly associated with: age, male gender, glycemic control, untreated sleep apnea (Steatosis and fibrosis); body mass index and dyslipidemia (Steatosis and NASH); diabetes and hypertension (Fibrosis) and COPD severity (Steatosis). Conclusion: NALFD is highly prevalent in COPD and might participate to cardiovascular and metabolic co-morbidities.