Review ArticleNonalcoholic Fatty Liver Disease and Type 2 Diabetes Mellitus: The Hidden Epidemic
Section snippets
PATHOGENESIS OF NAFLD/NASH
Cellular processes that have been well studied with respect to the pathogenesis of NAFLD include IR, oxidative stress and hepatic stellate cell.12 NAFLD is associated with whole body, adipose tissue and hepatic IR, which cause hypertriglyceridemia and high free fatty acids (FFAs); both are associated with increased visceral adiposity.13 The mechanism by which increased visceral adiposity leads to IR is unclear, although previous studies have shown that circulating hormones secreted from adipose
IR, NAFLD AND DIABETES MELLITUS
IR is known to play a key role in the pathophysiology of NAFLD.17., 18. In addition, studies suggest that a higher degree of IR (>2) is associated with a higher likelihood of the development of steatohepatitis in patients with steatosis.19 Patients with NASH have higher homeostasis model assessment (HOMA) scores, serum insulin levels and C-peptide levels compared with controls.17 HOMA-IR is calculated as insulin (mU/L) × [glucose (mg/dL) × 0.055]/22.5.20 It is well established that patients
DIAGNOSIS OF NAFLD/NASH
Clinicians need to consider that NAFLD/NASH is the most likely cause of liver test abnormalities in the presence of metabolic risk factors and when other causes of liver disease have been excluded. NAFLD/NASH is usually suspected because of abnormal liver biochemical tests in an apparently healthy person with no symptoms. However, fatigue or vague discomfort over the liver with hepatomegaly is common. The presence of a shrunken liver or more rarely a palpable spleen, ascites, jaundice or
TREATMENT OF NAFLD
NAFLD is largely a manifestation of obesity and metabolic syndrome and is characterized by excess calorie intake and lack of optimal health-related fitness or physical activity.48 The current view of NAFLD as a serious condition with the potential for considerable morbidity and mortality has stimulated the search for strategies ranging from lifestyle changes to a variety of pharmacological interventions.
LONG-TERM OUTCOME OF NAFLD AND T2DM
The long-term prognosis of NAFLD in T2DM has been poorly described in published literature. The liver-related mortality is significantly higher in patients with NASH than with simple steatosis. A recent population-based study68 reports an 80% increase in mortality in 256 patients with elevated liver enzymes who underwent liver biopsy and had a mean follow up of 21 years. At the time of the initial biopsy, 8% of those with NAFLD had cirrhosis, and 43% had NASH. However, the overall survival was
CONCLUSIONS
NAFLD has become a significant and challenging epidemic worldwide. NAFLD is no longer considered a benign condition in patients with T2DM. The possibility of fatty liver disease should be entertained as a part of the routine evaluation of patients with T2DM, in the same way that we search for microvascular complications and cardiovascular disease. Liver biopsy remains the current gold standard for the diagnosis of NASH and for assessment of the extent of fibrosis. Many advances have been made
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Use of noninvasive scores for advanced liver fibrosis can guide the need for hepatic biopsy during bariatric procedures
2021, Surgery for Obesity and Related DiseasesRisk factors and prevalence of liver disease in review of 2557 routine liver biopsies performed during bariatric surgery
2019, Surgery for Obesity and Related DiseasesCitation Excerpt :Stage 2 to 4 fibrosis was found in 7.8%. Our work confirms an association between NAFLD and diabetes and builds on prior studies by showing an association with preoperative laboratory abnormalities, most notably elevated transaminases, an AST to ALT ratio >.8, and reduced HDL [9,16]. As with prior studies in patients undergoing bariatric operations (but unlike the general population), we did not see a significant association with age or BMI in multivariable analysis [8].
Nonalcoholic fatty liver disease in patients with different baseline glucose status undergoing bariatric surgery: analysis of intraoperative liver biopsies and literature review
2018, Surgery for Obesity and Related DiseasesCitation Excerpt :Other authors have reported a high incidence of liver damage in obese patients with NAFLD, which is now considered the hepatic manifestation of the metabolic syndrome [16,25]. According to Ismail [26], patients with diabetes and NAFLD showed a 2.4 times greater risk of mortality compared with diabetics without NAFLD. He suggests that diabetic patients should be routinely evaluated for NAFLD, much like microvascular complications and cardiovascular disease.
Bisphenol A alters gut microbiome: Comparative metagenomics analysis
2016, Environmental PollutionCitation Excerpt :Current evidence shows that alteration of the gut microbiota plays an important role in animal physiology and pathophysiology (Festi et al., 2014; Ojeda et al., 2015). The incidence of metabolic diseases (i.e., obesity, diabetes, and fatty liver) has become highly prevalent globally (Chiang et al., 2011; Ismail, 2011). Although genetic and nutritional factors have been found to be associated with the development of diseases like type 2 diabetes (T2D) and obesity (Casals-Casas and Desvergne, 2011; Rinaudo and Wang, 2011), emerging evidence has included two additional contributing factors: (i) gut microbial communities and (ii) environmental “obesogens” (Alonso-Magdalena et al., 2011) such as bisphenol A (BPA).
Lipid and liver abnormalities in haemoglobin A1c-defined prediabetes and type 2 diabetes
2014, Nutrition, Metabolism and Cardiovascular DiseasesCitation Excerpt :Moreover, non-alcoholic fatty liver disease (NAFLD) has been shown to be markedly increased in type 2 diabetes [6] – and to a lower extent in prediabetes [7] – diagnosed from plasma glucose measurements. NAFLD is promoted by overweight [6], dyslipidaemia [8], and diabetes [9], and is considered the hepatic expression of the metabolic dysfunctions induced by insulin resistance. The overall mortality in patients with NAFLD is significantly higher than the background population [10].