Non-alcoholic fatty liver disease in type 1 diabetes: Prevalence and pathophysiology

Abstract

Non-alcoholic fatty liver disease (NAFLD) is the most frequent chronic liver disease in the general population with a global prevalence of 25%. It is often associated with metabolic syndrome and type 2 diabetes, as insulin resistance and hyperinsulinemia are known to be favoring factors. Recent studies have described growing incidence of NAFLD in type 1 diabetes (T1D) as well. Although increasing prevalence of metabolic syndrome in these patients seems to explain part of this increase in NAFLD, other underlying mechanisms may participate in the emergence of NAFLD. Notably, some genetic factors are more associated with fatty liver disease, but their prevalence in T1D has not been evaluated. Moreover, oxidative stress, poor glucose control and long-lasting hyperglycemia, as well as exogenous insulin administration play an important role in intrahepatic fat homeostasis. The main differential diagnosis of NAFLD in T1D is glycogenic hepatopathy, which needs to be considered mostly in T1D patients with poor glycemic control. This article aims to review the prevalence and pathophysiology of NAFLD in T1D and open perspectives for clinicians taking care of T1D patients with potential hepatopathy.

Insights into Hepatocellular Carcinoma in Patients with Thalassemia: From Pathophysiology to Novel Therapies

“…Altered dynamic insulin pulsatile, altered insulin clearance, hyperglucagonemia, and hepatic glucagon resistance are parts of NAFLD pathogenesis in type 1 DM. These are slightly different from type 2 DM and metabolic syndrome patients [ 27 ]. Although there are no formal statistics of NAFLD prevalence in thalassemic patients, we inferred that owing to type 1 DM and iron overload (discussed next), the prevalence of NAFLD would be high in thalassemic patients.…”

Influence of genetically predicted autoimmune diseases on NAFLD

“…T1D is characterized by pancreatic β-cell destruction leading to hyperglycemia and lifelong insulin reliance. The current view is that the presence of T1D exacerbates intrahepatic fat accumulation mainly through acquired insulin resistance (IR) ( 63 ). IR is a hit in the current multiple-hit theory of NAFLD ( 64 ), besides traditional factors such as sedentary, high-calorie diet, insulin dynamics in the portal circulation, genetic and epigenetic factors, and gut microbiota may contribute to hepatic and peripheral IR in T1D patients ( 65 ), leading to NAFLD.…”

Overweight and Obesity in Adults with Type 1 Diabetes: A Growing Challenge

“…NAFLD, associated with insulin resistance and metabolic syndrome, can progress to non-alcoholic steatohepatitis (NASH), cirrhosis, and hepatocellular carcinoma. Furthermore, obesity is one of the major risk factors for obstructive sleep apnea, which is associated with an increased risk of cardiovascular disease [41].…”