Non-alcoholic Fatty Liver Disease (NAFLD) as a Neglected Metabolic Companion of Psychiatric Disorders: Common Pathways and Future Approaches
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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.
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Neuropsychiatric conditions such as depression, anxiety, psychosis, and cognitive impairment are often prevalent in patients with chronic kidney disease, non-alcoholic fatty liver disease, and autoimmune disorders.
“Neuropsychiatric conditions, such as depression, anxiety, psychosis, and cognitive impairment, are often prevalent in patients with chronic kidney disease (CKD), non-alcoholic fatty liver disease (NAFLD), and autoimmune disorders”
From A Critical Review and Meta-Analysis of Impacts of Per- and Polyfluorinated Substances on the Brain and Behavior (2022) · cites this paper as Soto-Angona et al., 2020
The Epidemiology and natural history section reports higher rates of depression and generalized anxiety disorder in people with NASH, supporting part of the NAFLD-related claim. It discusses NAFLD prevalence in people with schizophrenia, but not psychosis prevalence in people with NAFLD. The paper lists chronic kidney disease as a shared medical comorbidity and does not establish the claimed psychiatric prevalence in CKD or autoimmune disorders, or address cognitive impairment in those groups. (LLM, conf=0.88)
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Starnes, H. M., Rock, K. D., Jackson, T. W., & Belcher, S. M. (2022) · Frontiers in Toxicology · doi:10.3389/ftox.2022.881584 · Cited by 166 · see citing works
“Neuropsychiatric conditions, such as depression, anxiety, psychosis, and cognitive impairment, are often prevalent in patients with chronic kidney disease (CKD), non-alcoholic fatty liver disease (NAFLD), and autoimmune disorders (Jeppesen and Benros, 2019; Simões e Silva et al., 2019; Soto-Angona et al., 2020).”
BackgroundTeixeira, A. L., Martins, L. B., Berk, M., & Bauer, M. E. (2022) · Clinical Science · doi:10.1042/cs20211106 · Cited by 22 · see citing works
Self-citationManagement of psychiatric disorders in patients with hepatic and gastrointestinal diseases
Menon, V., Ransing, R., & Praharaj, S. K. (2022) · Indian Journal of Psychiatry · doi:10.4103/indianjpsychiatry.indianjpsychiatry_18_22 · Cited by 19 · see citing works
Filipovic, B. F., Latas, M., Kiurski, S., Al Kiswani, D., Filipovic, N., Marjanovic-Haljilji, M., Laketic, D., Aksic, M., Markovic, B., Kapor, S., et al. (2021) · Journal of Gastrointestinal and Liver Diseases · doi:10.15403/jgld-3758 · Cited by 2 · see citing works
- Authors
- Soto-Angona, Ó., Anmella, G., Valdés-Florido, M. J., De Uribe-Viloria, N., Carvalho, A. F., Penninx, B. W. J. H., & Berk, M.
- Affiliations
- Barwon Health (AU)
- Hospital Universitario Virgen Macarena (ES)
- Amsterdam Neuroscience (NL)
- Corresponding author
- Soto-Angona, Óscar
- ORCID
- Venue
- BMC Medicine
- Published
- 2020-10-01
- Volume
- 18
- Issue
- 1
- Pages
- 261-261
- ISSN
- 1741-7015 (ISSN-L)
- OpenAlex
- W3089361150
- Cited by
- 122
- References
- 127
- Citations by year
- 2026: 16 · 2025: 20 · 2024: 21 · 2023: 22 · 2022: 24 · 2021: 18 · 2020: 1
- FWCI
- 2.37
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- BMC Medicine (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion, other-oa)
- RISalud Institutional Health Repository of Andalucía (submittedVersion, cc-by)
- Minerva Access (University of Melbourne) (submittedVersion, cc-by)
- TSpace (University of Toronto) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Own your potential (DEAKIN) (submittedVersion)
- Figshare (submittedVersion, cc-by)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Funders
- National Health and Medical Research Council (1156072)
- Topics
- Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
- Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
- Health Sciences › Medicine › Hepatology › Liver Diseases and Immunity
- Keywords
- non-alcoholic fatty liver disease, nonalcoholic steatohepatitis, mental illness, comorbidities, metabolic syndrome, cardiometabolic disease, hepatic steatosis, inflammation, oxidative stress, mitochondrial dysfunction, lifestyle factors, genetic risk factors, NAFLD treatment
- MeSH terms
- Mental Disorders, Humans, Quality of Life, Oxidative Stress, Metabolic Syndrome, Non-alcoholic Fatty Liver Disease
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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