Fig. 2. Shared risk factors for metabolic dysfunction-associated steatohepatitis (MASH) and osteoporosis. Adipose tissue dysfunction (adiposopathy) gives rise to adipose tissue insulin resistance and proinflammatory cytokines. Excess free fatty acids (FFAs) from dysfunctional adipose tissue are diverted to the liver, which ultimately is overwhelmed. This results in the storage of excess FFAs as triglycerides in hepatocytes (steatosis) and gives rise to hepatic insulin resistance and MASH. Proinflammatory cytokines (from adipose tissue and fibrosed liver) also result in muscle loss (sarcopenia) and bone loss (osteoporosis). T2DM, type 2 diabetes mellitus.
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