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Mechanisms,screening modalities and treatment options for individuals with non-alcoholic fatty liver disease and type 2 diabetes |
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| Authors: | T J Hydes N Summers E Brown U Alam H Thomaides-Brears J P H Wilding D J Cuthbertson |
| Institution: | 1. Department of Gastroenterology and Hepatology, University Hospital Southampton NHS Foundation Trust, Southampton, UK;2. Liverpool University Hospitals NHS Foundation Trust, University Hospital Aintree, Liverpool, UK
Joint senior authors;3. Institute of Cardiovascular and Metabolic Medicine, University of Liverpool, Liverpool, UK;4. Institute of Cardiovascular and Metabolic Medicine, University of Liverpool, Liverpool, UK Metabolism and Nutrition Research Group, Clinical Sciences Centre, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK Division of Diabetes, Endocrinology and Gastroenterology, Institute of Human Development, University of Manchester, Manchester, UK;5. Perpsectum Gemini One, Oxford, UK;6. Institute of Cardiovascular and Metabolic Medicine, University of Liverpool, Liverpool, UK Metabolism and Nutrition Research Group, Clinical Sciences Centre, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK |
| Abstract: | Non-alcoholic fatty liver disease (NAFLD) exists as a spectrum of disease ranging from excessive accumulation of fat within the liver (simple steatosis), inflammation (non-alcoholic steatohepatitis) through to fibrosis, cirrhosis and end-stage liver disease. There is also an increased risk of hepatocellular carcinoma. The principal risk factor for NAFLD is overweight or obesity, along with type 2 diabetes, and NAFLD itself is also a risk factor for incident type 2 diabetes. Overweight/obesity is synergistic with alcohol consumption in causing progressive and insidious liver damage. Recent consensus advocates a change in nomenclature from NAFLD to ‘metabolic associated fatty liver disease’ (MAFLD), reflective of the associated metabolic abnormalities (insulin resistance/type 2 diabetes and metabolic syndrome components). Additional extra-hepatic manifestations of NAFLD include cardiovascular disease, chronic kidney disease and certain cancers. Unlike other micro- and macrovascular complications of type 2 diabetes, systematic screening or surveillance protocols have not been widely adopted in routine diabetes care to assess for presence/severity of NAFLD. Various screening tools are available (non-invasive tests and biochemical indices) combined with imaging techniques (e.g. transient elastography) to detect steatosis and more importantly advanced fibrosis/cirrhosis to facilitate appropriate surveillance. Liver biopsy may be sometimes necessary. Treatment options for type 2 diabetes, including lifestyle interventions (dietary change and physical activity), glucose-lowering therapies and metabolic surgery, can modulate hepatic steatosis and to a lesser extent fibrosis. Awareness of the impact of liver disease on the choice of glucose-lowering medications in individuals with type 2 diabetes is also critical. |
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