Non-Alcoholic Fatty Liver Disease or Type 2 Diabetes Mellitus—The Chicken or the Egg Dilemma

Abstract

In clinical practice, we often deal with patients who suffer from non-alcoholic fatty liver disease (NAFLD) concurrent with type 2 diabetes mellitus (T2DM). The etiopathogenesis of NAFLD is mainly connected with insulin resistance (IR) and obesity. Similarly, the latter patients are in the process of developing T2DM. However, the mechanisms of NAFLD and T2DM coexistence have not been fully elucidated. Considering that both diseases and their complications are of epidemic proportions and significantly affect the length and quality of life, we aimed to answer which of these diseases appears first and thereby highlight the need for their diagnosis and treatment. To address this question, we present and discuss the epidemiological data, diagnoses, complications and pathomechanisms of these two coexisting metabolic diseases. This question is difficult to answer due to the lack of a uniform procedure for NAFLD diagnosis and the asymptomatic nature of both diseases, especially at their beginning stages. To conclude, most researchers suggest that NAFLD appears as the first disease and starts the sequence of circumstances leading ultimately to the development of T2DM. However, there are also data suggesting that T2DM develops before NAFLD. Despite the fact that we cannot definitively answer this question, it is very important to bring the attention of clinicians and researchers to the coexistence of NAFLD and T2DM in order to prevent their consequences.

A Machine Learning-Based Method for Detecting Liver Fibrosis

“…As the gallbladder mucosa has its role in insulin regulation, cholecystectomy is associated with increased manifestations of IR due to dysregulation of these mechanisms. This has been shown in some studies, where people after cholecystectomy have an increase in fat levels, apolipoprotein B, insulin and in the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) index [ 64 , 69 ]. The worsening of metabolic syndrome is linked to an aggravation of the MASLD condition and a high risk of progression in hepatic fibrosis.…”

Exploring the interconnected between type 2 diabetes mellitus and nonalcoholic fatty liver disease: Genetic correlation and Mendelian randomization analysis

“…However, many factors are also involved in their development. These include genetic predispositions, [ 31 , 32 ] environmental and lifestyle influences, [ 33 ] intestinal microbiome alterations, [ 34 , 35 ] IR, [ 36 ] and disturbances in lipid and glucose metabolisms. [ 37 ] The development of NAFLD is strongly associated with hepatic IR.…”

Comparative Analysis of Different Proteins and Metabolites in the Liver and Ovary of Local Breeds of Chicken and Commercial Chickens in the Later Laying Period

“…Sorbitol catalyzes the conversion of fructose in the liver. Excess fructose increases liver stress and contributes to the accumulation of fat [ 42 ]. Additionally, the more abundant lipids and lipid-like molecules in the liver of Group G were o-phosphoethanolamine and taurocholate; taurocholate is involved in the biosynthesis of primary bile acid, and bile acid can promote the digestion and absorption of fat [ 43 ].…”