EC Pulmonology and Respiratory Medicine

Review Article Volume 14 Issue 1 - 2025

Where We Now Stand: Unraveling the Link between COPD and NAFLD

Zorica Nikleski1, Maja Avramovska2, Petar Avramovski3*, Liljana Todorovska4, Vesna Sikloska5, Dejan Zdraveski6, Irena Trajceska5, Saso Vasilevski5, Aleksandar Dimovski5 and Svetlana Stefanovska3

1Medico - Legal Department, MedAssess, Sydney, New South Wales, Australia

2Department of Gynecology and Obstetrics, University St. Clement of Ohrid - Bitola, Clinical Hospital - Bitola, Bitola, North Macedonia

3Department of Internal Medicine, University St. Clement of Ohrid - Bitola, Clinical Hospital - Bitola, Bitola, North Macedonia

4Department of Nuclear Medicine, Clinical Hospital - Bitola, North Macedonia

5Department of Radiology, Clinical Hospital - Bitola, Bitola, North Macedonia

6Department of Cloud Computing, Faculty of Economics - Prilep, University St. Clement of Ohrid - Bitola, Prilep, North Macedonia

*Corresponding Author: Petar Avramovski, Professor, Department of Internal Medicine, University St. Clement of Ohrid - Bitola, Clinical Hospital - Bitola, Bitola, North Macedonia.
Received: November 13, 2024; Published:December 09, 2024



Chronic obstructive pulmonary disease (COPD) and non-alcoholic fatty liver disease (NAFLD) are both prevalent and significant contributors to global morbidity and mortality. Despite their distinct pathophysiological mechanisms and target organs, emerging evidence suggests an interrelationship between these two conditions. This review aims to explore the current understanding of the potential link between COPD and NAFLD, discussing shared risk factors, underlying mechanisms, and clinical implications. Through an examination of epidemiological studies, biological pathways, and therapeutic approaches, we aim to illuminate the bidirectional relationship between these diseases and emphasize the need for integrated management strategies.

 Keywords: Chronic Obstructive Pulmonary Disease (COPD); Non-Alcoholic Fatty Liver Disease (NAFLD); Global Morbidity and Mortality

  1. Viglino D., et al. “Nonalcoholic fatty liver disease in chronic obstructive pulmonary disease”. European Respiratory Journal 6 (2017): 1601923.
  2. Rinella ME., et al. “AASLD Practice Guidance on the clinical assessment and management of nonalcoholic fatty liver disease”. Hepatology5 (2023): 1797-1835.
  3. Zhang QQ and Lu LG. “Nonalcoholic fatty liver disease: dyslipidemia, risk for cardiovascular complications, and treatment strategy”. Journal of Clinical and Translational Hepatology 1 (2015): 78-84.
  4. Zheng D., et al. “Association of hepatic steatosis and liver fibrosis with chronic obstructive pulmonary disease among adults”. Scientific Reports 1 (2024): 10822.
  5. Tsutsumi T., et al. “MAFLD associated with COPD via systemic inflammation independent of aging and smoking in men”. Diabetology and Metabolic Syndrome 1 (2022): 115.
  6. Botello-Manilla AE., et al. “Hepatic steatosis and respiratory diseases: a new panorama”. Annals of Hepatology 24 (2021): 100320.
  7. Malnick SDH and Zamir D. “From non-alcoholic fatty liver disease to metabolic-associated steatotic liver disease: Rationale and implications for the new terminology”. World Journal of Hepatology 6 (2024): 863-866.
  8. Zheng D., et al. “Association of hepatic steatosis and liver fibrosis with chronic obstructive pulmonary disease among adults”. Scientific Reports 1 (2024): 10822.
  9. Lu W., et al. “Tobacco and COPD: presenting the World Health Organization (WHO) Tobacco Knowledge Summary”. Respiratory Research 1 (2024): 338.
  10. Moon SW., et al. “Relationship between obstructive lung disease and non-alcoholic fatty liver disease in the Korean population: Korea National Health and Nutrition Examination Survey, 2007-2010”. International Journal of Chronic Obstructive Pulmonary Disease 13 (2018): 2603-2611.
  11. Wagih Shaltout S., et al. “Clinical spectrum of nonalcoholic fatty liver disease in patients with chronic obstructive pulmonary disease”. Turkish Thoracic Journal 6 (2022): 420-425.
  12. Tanase DM., et al. “The intricate relationship between type 2 diabetes mellitus (T2DM), insulin resistance (IR), and nonalcoholic fatty liver disease (NAFLD)”. Journal of Diabetes Research (2020): 3920196.
  13. Feng T., et al. “Association between metabolic dysfunction-associated steatotic liver disease and pulmonary function: a population-based and two-sample mendelian randomization study”. BMC Pulmonary Medicine 1 (2024): 368.
  14. Lonardo A., et al. “Nonalcoholic fatty liver disease and COPD: is it time to cross the diaphragm?” European Respiratory Journal 6 (2017): 1700546.
  15. Kotlyarov S and Bulgakov A. “Lipid metabolism disorders in the comorbid course of nonalcoholic fatty liver disease and chronic obstructive pulmonary disease”. Cells 11 (2021): 2978.
  16. Tanase DM., et al. “The intricate relationship between type 2 diabetes mellitus (T2DM), insulin resistance (IR), and nonalcoholic fatty liver disease (NAFLD)”. Journal of Diabetes Research (2020): 3920196.
  17. Yan R., et al. “Hypoxia-inducible factor-2α promotes fibrosis in non-alcoholic fatty liver disease by enhancing glutamine catabolism and inhibiting yes-associated protein phosphorylation in hepatic stellate cells”. Frontiers in Endocrinology (Lausanne) 15 (2024): 1344971.
  18. Petrescu M., et al. “Chronic inflammation-a link between nonalcoholic fatty liver disease (NAFLD) and dysfunctional adipose tissue”. Medicina (Kaunas)5 (2022): 641.

Petar Avramovski., et al. "Where We Now Stand: Unraveling the Link between COPD and NAFLD". EC Pulmonology and Respiratory Medicine  14.1 (2025): 01-08.