Topic Highlight
Copyright ©2014 Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 14, 2014; 20(26): 8377-8392
Published online Jul 14, 2014. doi: 10.3748/wjg.v20.i26.8377
Non-alcoholic fatty liver disease and diabetes: From physiopathological interplay to diagnosis and treatment
Nathalie C Leite, Cristiane A Villela-Nogueira, Claudia R L Cardoso, Gil F Salles
Nathalie C Leite, Cristiane A Villela-Nogueira, Claudia R L Cardoso, Gil F Salles, Internal Medicine Department, University Hospital Clementino Fraga Filho, School of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro 22750-240, Brazil
Author contributions: Leite NC and Villela-Nogueira CA contributed equally to this work, both reviewed the subject and drafted the manuscript; Cardoso CRL and Salles GF reviewed the manuscript and contributed with intellectual content.
Supported by Conselho Brasileiro de Desenvolvimento Científico e Tecnológico (CNPq-Brasil) and Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ-Brasil)
Correspondence to: Gil F Salles, MD, PhD, Professor, Internal Medicine Department, University Hospital Clementino Fraga Filho, School of Medicine, Universidade Federal do Rio de Janeiro, Rua Croton 72, Rio de Janeiro 22750-240, Brazil. gilsalles@hucff.ufrj.br
Telephone: +55-21-24473577 Fax: +55-21-25622514
Received: October 26, 2013
Revised: December 1, 2013
Accepted: January 19, 2014
Published online: July 14, 2014
Processing time: 260 Days and 21 Hours
Abstract

Non-alcoholic fatty liver disease (NAFLD) is highly prevalent in patients with diabetes mellitus and increasing evidence suggests that patients with type 2 diabetes are at a particularly high risk for developing the progressive forms of NAFLD, non-alcoholic steatohepatitis and associated advanced liver fibrosis. Moreover, diabetes is an independent risk factor for NAFLD progression, and for hepatocellular carcinoma development and liver-related mortality in prospective studies. Notwithstanding, patients with NAFLD have an elevated prevalence of prediabetes. Recent studies have shown that NAFLD presence predicts the development of type 2 diabetes. Diabetes and NAFLD have mutual pathogenetic mechanisms and it is possible that genetic and environmental factors interact with metabolic derangements to accelerate NAFLD progression in diabetic patients. The diagnosis of the more advanced stages of NAFLD in diabetic patients shares the same challenges as in non-diabetic patients and it includes imaging and serological methods, although histopathological evaluation is still considered the gold standard diagnostic method. An effective established treatment is not yet available for patients with steatohepatitis and fibrosis and randomized clinical trials including only diabetic patients are lacking. We sought to outline the published data including epidemiology, pathogenesis, diagnosis and treatment of NAFLD in diabetic patients, in order to better understand the interplay between these two prevalent diseases and identify the gaps that still need to be fulfilled in the management of NAFLD in patients with diabetes mellitus.

Keywords: Non-alcoholic fatty liver disease; Diabetes mellitus; Pathogenesis; Diagnosis; Treatment

Core tip: This review addresses the important interplay between non-alcoholic fatty liver disease and diabetes mellitus, with particular emphasis on physiopathological mechanisms, diagnosis and treatment.