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Review
. 2020 Jun 5:6:9.
doi: 10.1186/s40842-020-00097-1. eCollection 2020.

Nonalcoholic fatty liver disease and type 2 diabetes: where do Diabetologists stand?

Shaheen Tomah  1   2 , Naim Alkhouri  3 , Osama Hamdy  1   2
Affiliations
Review

Nonalcoholic fatty liver disease and type 2 diabetes: where do Diabetologists stand?

Shaheen Tomah et al. Clin Diabetes Endocrinol. .

Abstract

Background: Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease worldwide. The increasing prevalence of NAFLD mirrors that of obesity and type 2 diabetes over the last two decades.

Main: In a two-way pathophysiologic relationship, NAFLD increases the risk of developing type 2 diabetes, while the latter promotes the progression of simple fatty liver to a more advanced form called nonalcoholic steatohepatitis (NASH). NASH increases the risk of cirrhosis and hepatocellular carcinoma (HCC), which may require liver transplantation. With the absence of FDA-approved medications for NAFLD treatment, lifestyle intervention remains the only therapy. Lately, extensive research efforts have been aimed at modifying NASH fibrosis and developing noninvasive screening methods.

Conclusion: We highlight the pathophysiologic relationships between NAFLD and type 2 diabetes, discuss disease recognition, models of care, and current and emerging therapies for NASH treatment.

Keywords: Awareness; Nonalcoholic fatty liver disease; Nonalcoholic steatohepatitis; Pathophysiology; Screening; Treatment; Type 2 diabetes.

PubMed Disclaimer

Conflict of interest statement

Competing interestsS.T. has nothing to disclose. N.A. advises, is on the speakers’ bureau for, and received grants from Gilead and Intercept. He advises and received grants from Allergan. He received grants from GENFIT, Madrigal, and Galmed. O.H. reports consultation to Abbott Nutrition, Gilead Inc. and Merck Sorono, grants from National Dairy Council, and own shares in Heathimation Inc. outside the submitted work.

Figures

Fig. 1
Fig. 1
Nonalcoholic fatty liver disease and type 2 diabetes in publications over four decades. Based on data from Pubmed.gov literature search with the keywords: nonalcoholic fatty liver disease OR type 2 diabetes. Abbreviations: NAFLD, nonalcoholic fatty liver disease; T2D, type 2 diabetes
Fig. 2
Fig. 2
Key players in the development of NAFLD/NASH comprising mechanisms in the gut, adipose tissue and liver. Abbreviations: FFA, free fatty acid; NAFL, nonalcoholic fatty liver; DNL, de novo lipogenesis; NASH, nonalcoholic steatohepatitis
Fig. 3
Fig. 3
Proposed algorithm to screen patients with type 2 diabetes for NAFLD Patients with type 2 diabetes and suspected NAFLD can be risk-stratified using a combination of noninvasive scores/imaging. Indeterminate- and High-risk patients can then be prioritized for specialty referral for further investigation. 1Cut-off values reported by Angulo et al. [58]. NFS is calculated using the formula: NFS =  −1.675 + 0.037 – age (years) + 0.094 – BMI (kg/m2) + 1.13 × IFG/diabetes (yes = 1, no = 0) + 0.99 × AST/ALT ratio – 0.013 × platelet count (×109/l) – 0.66 × albumin (g/dl). (https://nafldscore.com/). FIB-4 is calculated using the formula: FIB-4 = Age (years)×AST (U/L)/[PLT(109/L)×ALT1/2 (U/L)] (https://www.hepatitisc.uw.edu/page/clinical-calculators/fib-4). 2Cut-off values reported by Tapper et al. [52]. 3Rosenberg et al. [59]. Abbreviations: T2D, type 2 diabetes; NAFLD, nonalcoholic fatty liver disease; US, ultrasonography; ALT, alanine aminotransferase; FIB-4, fibrosis index-4; NFS, NAFLD fibrosis score; VCTE, vibration-controlled transient elastography; ELF, enhanced liver fibrosis; MRE, magnetic resonance elastography; HCC, hepatocellular carcinoma; FDA, US food and drug administration.
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