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Review
. 2022 Sep 15;13(9):668-682.
doi: 10.4239/wjd.v13.i9.668.

Nonalcoholic fatty liver disease and diabetes

Maria Irene Bellini  1 , Irene Urciuoli  2 , Giovanni Del Gaudio  3 , Giorgia Polti  3 , Giovanni Iannetti  3 , Elena Gangitano  4 , Eleonora Lori  2 , Carla Lubrano  4 , Vito Cantisani  3 , Salvatore Sorrenti  2 , Vito D'Andrea  2
Affiliations
Review

Nonalcoholic fatty liver disease and diabetes

Maria Irene Bellini et al. World J Diabetes. .

Abstract

Nonalcoholic fatty liver disease (NAFLD) is the most prevalent chronic liver disease in the world and represents a clinical-histopathologic entity where the steatosis component may vary in degree and may or may not have fibrotic progression. The key concept of NAFLD pathogenesis is excessive triglyceride hepatic accumulation because of an imbalance between free fatty acid influx and efflux. Strong epidemiological, biochemical, and therapeutic evidence supports the premise that the primary pathophysiological derangement in most patients with NAFLD is insulin resistance; thus the association between diabetes and NAFLD is widely recognized in the literature. Since NAFLD is the hepatic manifestation of a metabolic disease, it is also associated with a higher cardio-vascular risk. Conventional B-mode ultrasound is widely adopted as a first-line imaging modality for hepatic steatosis, although magnetic resonance imaging represents the gold standard noninvasive modality for quantifying the amount of fat in these patients. Treatment of NAFLD patients depends on the disease severity, ranging from a more benign condition of nonalcoholic fatty liver to nonalcoholic steatohepatitis. Abstinence from alcohol, a Mediterranean diet, and modification of risk factors are recommended for patients suffering from NAFLD to avoid major cardiovascular events, as per all diabetic patients. In addition, weight loss induced by bariatric surgery seems to also be effective in improving liver features, together with the benefits for diabetes control or resolution, dyslipidemia, and hypertension. Finally, liver transplantation represents the ultimate treatment for severe nonalcoholic fatty liver disease and is growing rapidly as a main indication in Western countries. This review offers a comprehensive multidisciplinary approach to NAFLD, highlighting its connection with diabetes.

Keywords: Bariatric surgery; Diabetes; Hepatic steatosis; Liver fibrosis; Nonalcoholic fatty liver disease; Nonalcoholic steatohepatitis.

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Conflict of interest statement

Conflict-of-interest statement: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Pathogenesis and evolution of nonalcoholic fatty liver disease. FFA: Fatty free acids; HCC: Hepatocellular carcinoma; ROS: Reactive oxygen species; VLDL: Very low-density lipoprotein.
Figure 2
Figure 2
The link between nonalcoholic fatty liver disease and diabetes pathogenesis. Nonalcoholic fatty liver disease increases the risk of developing type 2 diabetes mainly through worsening insulin resistance and increasing gluconeogenesis. By contrast, type 2 diabetes increases the risk of developing liver steatosis and fibrosis through insulin resistance, oxidative stress, and inflammatory cytokines.
Figure 3
Figure 3
Type 2 diabetes and nonalcoholic fatty liver disease are both associated with multiple metabolic and cardiovascular morbidities. Furthermore, the presence of one increases the risk to develop the other and thus exacerbating the overall prognosis. HCC: Hepatocellular carcinoma; NAFLD: Nonalcoholic fatty liver disease.
See this image and copyright information in PMC

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