Non-alcoholic fatty liver disease and diabetes

Abstract

Non-alcoholic fatty liver disease (NAFLD) and type 2 diabetes (T2DM) are common conditions that regularly co-exist and can act synergistically to drive adverse outcomes. The presence of both NAFLD and T2DM increases the likelihood of the development of complications of diabetes (including both macro- and micro- vascular complications) as well as augmenting the risk of more severe NAFLD, including cirrhosis, hepatocellular carcinoma and death.The mainstay of NAFLD management is currently to reduce modifiable metabolic risk. Achieving good glycaemic control and optimising weight loss are pivotal to restricting disease progression. Once cirrhosis has developed, it is necessary to screen for complications and minimise the risk of hepatic decompensation.Therapeutic disease modifying options for patients with NAFLD are currently limited. When diabetes and NAFLD co-exist, there are published data that can help inform the clinician as to the most appropriate oral hypoglycaemic agent or injectable therapy that may improve NAFLD, however most of these data are drawn from observations in retrospective series and there is a paucity of well-designed randomised double blind placebo controlled studies with gold-standard end-points. Furthermore, given the heterogeneity of inclusion criteria and primary outcomes, as well as duration of follow-up, it is difficult to draw robust conclusions that are applicable across the entire spectrum of NAFLD and diabetes. In this review, we have summarised and critically evaluated the available data, with the aim of helping to inform the reader as to the most pertinent issues when managing patients with co-existent NAFLD and T2DM.

Effect of exercise on the development of new fatty liver and the resolution of existing fatty liver

“…NAFLD comprises a complex spectrum of disease that begins with liver fat accumulation (non alcoholic fatty liver or NAFL) and progress with inflammation and fibrosis (non alcoholic steatohepatitis or NASH). There is now a wealth of evidence that NAFLD increases risk of type 2 diabetes (summarised in [1,4]) but there is limited evidence to date that treatment of NAFLD decreases risk of T2DM. We have shown previously that resolution of fatty liver (detected by ultrasound) over 5 years, was independently associated with marked attenuation of the risk of incident T2DM [5] and also incident hypertension [6], over five years of follow up.…”

Vascular endothelial growth factor-B: Impact on physiology and pathology

“…The NAFLD imposes the risk for the diabetes and its complications, in turn, diabetes makes an individual more likely to have more severe NAFLD with the associative complications of cirrhosis and mortality. 48

10.1080/19336918.2017.1379634-f0002Figure 2.The involvement of the VEGF-B in the lipids translation, and the observed phenotype in the targeted VEGF-B treatment in various rodent animals. The black line stands for the pathways under physical conditions; the red for the pathological conditions; the green for the changes after the neutralizing VEGF-B strategies (the VEGF-B −/− model or VEGF-B antibody treatment).

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“…The NAFLD imposes the risk for the diabetes and its complications, in turn, diabetes makes an individual more likely to have more severe NAFLD with the associative complications of cirrhosis and mortality. 48 …”

Prevalence, patterns and predictive factors of non-alcoholic fatty liver disease among morbidly obese patients undergoing sleeve gastrectomy

“…However, whether DM increases the risk of developing NAFLD was not clear. 40 In a large series of 432 patients, the coexistence of DM with NAFLD was found to be an independent risk factor for fibrosis. 41 The prevalence of NAFLD among DM patients varies with the method of diagnosis and the population studied; some studies have shown that NAFLD may be present in up to 70 per cent of patients with DM.…”