The neck-liver axis. Madelung disease as further evidence for an impact of body fat distribution on hepatic histology

tissue.A 49-year-old alcoholic man withMD(Fig. 1) fulfilling ATP IIIcriteria6 for arterial hypertension, waist girth and HDL cholesterol,and showing bull-like neck due to subcutaneuos lipoma in DCA,quit drinking alcohol when first observed in 2001. Subsequently,the patient was subjected to anthropometric laboratory evaluationand paired liver biopsy. Owing to neurological and respiratorycomplications, surgical removal of 5kg adipose tissue from the neck area was performed at 2 times (2005-2007). Follow-up of this patient (June 2001– June 2007) disclosed increasing body weight (90-148 kg) coupled with decreasing triglyceride serum levels (90-38mg/dL), as if the expanded adipose tissue were avidly absorbingcirculating triglycerides, thus removing them from the bloodstream.Paired liver biopsy showedalcoholic steatohepatitis in advanced fibrotic stage (2001) and precirrhoticchanges without steatosis (2006), as seen in NAFLD.studies support,therefore, hepatic steatosis to be a protective mechanism against freefatty acid toxicity in the liver. Conversely, selective accumulation offateb in the neck-DCA could be a risk factor for inflammatoryfibrotichepatic changes.