Eicosapentaenoic acid/arachidonic acid ratio as a possible link between non-alcoholic fatty liver disease and cardiovascular disease

Aim: The main causes of mortality from non-alcoholic fatty liver disease (NAFLD) are cardiovascular disease (CVD) and malignancy. Eicosapentaenoic acid (EPA)/arachidonic acid (AA) ratio is known to be associated with CVD. However, a possible link between EPA/AA ratio and NAFLD is not well known. In this study, we investigated EPA/AA ratio in Japanese patients with NAFLD.

Methods: Two hundred and fifty-four patients with biopsy-proven NAFLD were retrospectively enrolled. Serum EPA/AA ratios were examined for each generation (<35, 35-44, 45-54, 55-64, ≥65 years), and the differences of EPA/AA ratios were evaluated based on steatotic grades and fibrotic stages.

Results: EPA/AA ratio in NAFLD patients was decreased compared to that reported in age-matched healthy controls. EPA/AA ratio, body mass index, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol and steatotic grades in younger NAFLD patients were significantly worse than those in older NAFLD patients. Fasting glucose, hemoglobin A1c and fibrotic stages in older NAFLD patients were significantly higher than those in younger NAFLD patients. No relation was found between EPA/AA ratio and histological findings.

Conclusion: EPA/AA ratio was lower in NAFLD, especially in younger NAFLD patients. Considering the high mortality from CVD in NAFLD patients, low EPA/AA ratio in young age may influence the increased prevalence of CVD in their older age. EPA/AA ratio is suggested to be a possible link between NAFLD and CVD, and would become a useful marker for CVD in NAFLD.