Several diagnosed following an occasional ultrasound evaluation

Several epidemiological studies show thatobesity and related metabolic dysfunctions are associated with an increasedincidence and mortality rates for various types of tumors. For example, it hasbeen shown that obesity and type 2 diabetes are among the risk factorsassociated with the onset of colon cancer.Among the new emerging risk factors for theonset of extra-hepatic tumors, NAFLD has played an important role in thedevelopment of tumors of the gastro-intestinal tract. In addition NAFLD isstrongly associated with features of the metabolic syndrome, including obesity,insulin resistance, type 2 diabetes mellitus (DM2) and dyslipidemia.

It is known that among the risk factors for theonset of NAFLD there are the bad eating habits associated with a sedentarylifestyle, in this case a combination of dietary restrictions associated withphysical activity is commonly recommended for people with NAFLD.However, a significant proportion of patientsdevelop NAFLD despite having a normal body mass index (BMI) and some featuresof the metabolic syndrome.Today lifestyles are increasingly sedentary, andNAFLD has quickly become one of the most common causes of liver diseaseworldwide. NAFLD is a condition closely related to obesity, diabetes and metabolicsyndrome. It is often diagnosed following an occasional ultrasound evaluationof the abdomen, but in reality many cases are associated with other metabolicdisorders (hypertriglyceridaemia, hypercholesterolemia, hypertension),configuring the panel of the so-called “metabolic syndrome”.

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Visceral obesity isan important risk factor in the onset of NAFLD. In fact, the prevalence ofNAFLD increases with the increase in body mass index (BMI). An accumulation ofectopic fat, including visceral obesity and fatty liver, can lead to adiposetissue dysfunction with consequent alteration of adipocytokine levels. One ofthe key factors in the pathogenesis of NAFLD is determined by insulinresistance (IR) (Figure 1), NAFLD is therefore considered the hepatic componentof the metabolic syndrome (SM) or IR.

The state of chronic low-gradeinflammation due to obesity and the presence of NAFLD leads to the emergence ofa micro-environment favorable to the development of cancer and the onset ofinsulin resistance due to activation of the axis that regulates the insulin growthfactor-1 IGF-1 and insulin resulting in hyperinsulinemia. Through itsproliferative and anti-apoptotic effects, this process can increase mutationsthat promote carcinogenesis. NAFLD is now considered the liver manifestation ofthe metabolic syndrome (MS) and the latter, as shown by numerous studies,represents a condition that increases the risk of cancer, especially in thegastrointestinal tract. Colorectal cancer (CRC) has so far been consistently associatedwith NAFLD. The mechanisms that associate NAFLD with the risk of developingcancer are still not fully known, but they probably derive from the two-wayrelationship between NAFLD and the metabolic syndrome. NAFLD and visceral adipose tissue represent themain parts of the axis of central obesity.

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