title: Iron in fatty liver and in the metabolic syndrome: a promising therapeutic target.
abstract: The dysmetabolic iron overload syndrome (DIOS) is now a frequent finding in the general population, as is detected in about one third of patients with nonalcoholic fatty liver disease (NAFLD) and the metabolic syndrome. The pathogenesis is related to altered regulation of iron transport associated with steatosis, insulin resistance, and subclinical inflammation, often in the presence of predisposing genetic factors. Evidence is accumulating that excessive body iron plays a causal role in insulin resistance through still undefined mechanisms that probably involve a reduced ability to burn carbohydrates and altered function of adipose tissue. Furthermore, DIOS may facilitate the evolution to type 2 diabetes by altering beta-cell function, the progression of cardiovascular disease by contributing to the recruitment and activation of macrophages within arterial lesions, and the natural history of liver disease by inducing oxidative stress in hepatocytes, activation of hepatic stellate cells, and malignant transformation by promotion of cell growth and DNA damage. Based on these premises, the association among DIOS, metabolic syndrome, and NAFLD is being investigated as a new risk factor to predict the development of overt cardiovascular and hepatic diseases, and possibly hepatocellular carcinoma, but most importantly, represents also a treatable condition. Indeed, iron depletion, most frequently achieved by phlebotomy, has been shown to decrease metabolic alterations and liver enzymes in controlled studies in NAFLD. Additional studies are warranted to evaluate the potential of iron reductive therapy on hard clinical outcomes in patients with DIOS.
authors: Department of Internal Medicine, Centro Malattie Metaboliche del Fegato, Università degli Studi di Milano, and Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
authors: Paola
authors: P
authors: Dongiovanni
authors: Anna Ludovica
authors: AL
authors: Fracanzani
authors: Silvia
authors: S
authors: Fargion
authors: Luca
authors: L
authors: Valenti
mesh_terms: D005234:Fatty Liver / Q000453:epidemiology / Q000378:metabolism / Q000503:physiopathology*; D006432:Hemochromatosis / Q000453:epidemiology / Q000503:physiopathology* / Q000628:therapy*; D006801:Humans; D007501:Iron / Q000378:metabolism*; D024821:Metabolic Syndrome / Q000453:epidemiology / Q000378:metabolism / Q000503:physiopathology*; D065626:Non-alcoholic Fatty Liver Disease; D018384:Oxidative Stress / Q000502:physiology; D015995:Prevalence; D012307:Risk Factors
chemical_list: D007501:Iron