Abstract
The incidence of nonalcoholic fatty liver disease (NAFLD) is growing worldwide. Epidemiological data suggest a strong relationship between NAFLD and T2DM. This is associated with common risk factors and pathogenesis, where obesity, insulin resistance and dyslipidemia play pivotal roles. Expanding knowledge on the coexistence of NAFLD and T2DM could not only protect against liver damage and glucotoxicity, but may also theoretically prevent the subsequent occurrence of other diseases, such as cancer and cardiovascular disorders, as well as influence morbidity and mortality rates. In everyday clinical practice, underestimation of this problem is still observed. NAFLD is not looked for in T2DM patients; on the contrary, diagnosis for glucose metabolism disturbances is usually not performed in patients with NAFLD. However, simple and cost-effective methods of detection of fatty liver in T2DM patients are still needed, especially in outpatient settings. The treatment of NAFLD, especially where it coexists with T2DM, consists mainly of lifestyle modification. It is also suggested that some drugs, including hypoglycemic agents, may be used to treat NAFLD. Therefore, the aim of this review is to detail current knowledge of NAFLD and T2DM comorbidity, its prevalence, common pathogenesis, diagnostic procedures, complications and treatment, with special attention to outpatient clinics.
Highlights
The term nonalcoholic fatty liver disease (NAFLD) appeared more than 40 years ago, but neither its pathophysiology nor diagnostic criteria were established for many years [1]
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Bozzetto et al suggest that an isocaloric diet enriched in monounsaturated fatty acids (MUFA) compared with a diet higher in carbohydrate and fiber was associated with a clinically significantly lower hepatic fat content in T2DM patients independently of pursuit of an aerobic training program
Summary
The term nonalcoholic fatty liver disease (NAFLD) appeared more than 40 years ago, but neither its pathophysiology nor diagnostic criteria were established for many years [1]. NAFL can be diagnosed in cases of at least 5% hepatic steatosis without appearance of hepatocellular injury, while NASH is defined as at least 5% steatosis but with inflammation and hepatocyte injury (e.g., ballooning) In both histological types, fibrosis may or may not be observed [2]. With respect to the causes of excessive accumulation of triglycerides (TG) in the liver, there are two forms of NAFLD: primary and secondary, which have the same clinical and histological signs. The latter occurs in patients with metabolic syndrome (MetS), especially coexisting with type 2 diabetes mellitus (T2DM) [4]. The main aim of this review is to represent current knowledge on the coexistence of NAFLD and T2DM, its prevalence, common pathogenesis, diagnostic procedures and treatment, with special attention to outpatient clinics
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