Obesity is associated with increased risk of alcoholic liver disease (ALD). Moreover, abdominal obesity, is also seen to be correlated with insulin resistance on peripheral glucose and fatty acid utilization, resulting in type 2 diabetes mellitus. Insulin resistance, the associated hyperinsulinemia and hyperglycemia, and adipokines can also augment the risk for cardiovascular disease (CVD) due to vascular endothelial dysfunction, abnormal lipid profile, hypertension, and vascular inflammation. The presence of metabolic risk factors such as abdominal obesity, hyperglycemia, dyslipidemia, and hypertension for both type 2 diabetes and CVD establishes the existence of metabolic syndrome. 

Obesity and metabolic syndrome are highly prevalent and are considered as one of the most important public health concern due to their comorbidities in Western countries. The prevalence of the metabolic syndrome, as defined by the 2001 ATP III criteria, which was assessed in the third National Health and Nutrition Examination Survey (NHANES III, 1988 to 1994) was 22%. Moreover, the prevalence of obesity and metabolic syndrome in patients with ALD in the NHANES III cohort are 44.5% and 32.4% respectively. Although, obesity and metabolic syndrome are also reported to be related with higher liver-related mortality in patients with ALD, there was no evidence of increased overall mortality risk with either of them in this cohort. On he contrary, type 2 diabetes and insulin resistance both were found to be associated with increased overall mortality in patients with ALD. Therefore, this large population-based study showed harmful effect of concomitant obesity and components of metabolic syndrome in patients with ALD. Therefore, lifestyle interventions such as inhibiting alcohol consumption and promoting weight loss are the key approach for managing various components associated with metabolic syndrome.

Source: Chiang DJ, McCullough AJ. The impact of obesity and metabolic syndrome on alcoholic liver disease. Clin Liver Dis. 2014;18(1):157-163.