Non-alcoholic fatty liver disease and diabetes mellitus: bidirectional relationship

Abstract

To date, nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic diffuse liver disease. Under adverse conditions, its natural course involves progression from simple steatosis and nonalcoholic steatohepatitis (NASH) to the development of liver cirrhosis and hepatocellular carcinoma (HCC). In recent years, there has been much convincing evidence that NAFLD is a multisystem disease that contributes to damage to extrahepatic organs and systems, primarily increasing the risk of cardiovascular diseases, type 2 diabetes, chronic kidney disease and other diseases. In particular, numerous studies in recent years indicate that NAFLD increased the risk of diabetes by at least twice. Currently, the complex and bidirectional relationship between NAFLD and type 2 diabetes are well studied. NAFLD, hepatic and systemic insulin resistance, gut dysbiosis and lipotoxicity are the main factors determining the development of diabetes mellitus in predisposed individuals. Once type 2 diabetes manifests clinically, the likelihood of progressive liver damage increases. Non-alcoholic fatty liver disease, which is associated with type 2 diabetes, is thought to be a sign of a severe clinical course with serious clinical consequences in the form of NASH, liver cirrhosis and HCC. This combination requires a more aggressive therapeutic strategy, HCC screening, and long-term follow-up. A vicious circle is formed, which leads to adverse clinical consequences, worsens the prognosis and requires an active diagnostic and treatment strategy.