Non-alcoholic fatty liver disease (NAFLD) as a neglected metabolic companion of psychiatric disorders: Common pathways and future approaches

Óscar Soto-Angona, Gerard Anmella, María José Valdés-Florido, Nieves De Uribe-Viloria, Andre F. Carvalho, Brenda W.J.H. Penninx, Michael Berk

Research output: Contribution to JournalReview articleAcademicpeer-review

33 Citations (Scopus)


Background: Non-alcoholic fatty liver disease (NAFLD) is characterized by hepatic steatosis in over 5% of the parenchyma in the absence of excessive alcohol consumption. It is more prevalent in patients with diverse mental disorders, being part of the comorbidity driving loss of life expectancy and quality of life, yet remains a neglected entity. NAFLD can progress to non-alcoholic steatohepatitis (NASH) and increases the risk for cirrhosis and hepatic carcinoma. Both NAFLD and mental disorders share pathophysiological pathways, and also present a complex, bidirectional relationship with the metabolic syndrome (MetS) and related cardiometabolic diseases. Main text: This review compares the demographic data on NAFLD and NASH among the global population and the psychiatric population, finding differences that suggest a higher incidence of this disease among the latter. It also analyzes the link between NAFLD and psychiatric disorders, looking into common pathophysiological pathways, such as metabolic, genetic, and lifestyle factors. Finally, possible treatments, tailored approaches, and future research directions are suggested. Conclusion: NAFLD is part of a complex system of mental and non-communicable somatic disorders with a common pathogenesis, based on shared lifestyle and environmental risks, mediated by dysregulation of inflammation, oxidative stress pathways, and mitochondrial function. The recognition of the prevalent comorbidity between NAFLD and mental disorders is required to inform clinical practice and develop novel interventions to prevent and treat these complex and interacting disorders.

Original languageEnglish
Article number261
JournalBMC Medicine
Issue number1
Publication statusPublished - 1 Oct 2020


  • Inflammation
  • Lifestyle
  • Mental disorders
  • Metabolic syndrome
  • Mitochondrial
  • Non-alcoholic fatty liver disease
  • Non-alcoholic steatohepatitis
  • Non-communicable disorders
  • Oxidative stress
  • Psychiatry

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