Review
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 28, 2016; 22(44): 9674-9693
Published online Nov 28, 2016. doi: 10.3748/wjg.v22.i44.9674
Fatty liver is associated with an increased risk of diabetes and cardiovascular disease - Evidence from three different disease models: NAFLD, HCV and HIV
Amedeo Lonardo, Stefano Ballestri, Giovanni Guaraldi, Fabio Nascimbeni, Dante Romagnoli, Stefano Zona, Giovanni Targher
Amedeo Lonardo, Fabio Nascimbeni, Dante Romagnoli, Division of Internal Medicine and Metabolism, Nuovo Ospedale Civile Sant'Agostino Estense - Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia and Azienda Ospedaliera of Modena, 41126 Modena, Italy
Stefano Ballestri, Internal Medicine, Pavullo Hospital, Azienda Ospedaliera of Modena, 41126 Modena, Italy
Giovanni Guaraldi, Stefano Zona, Section of Infectious Diseases, Department of Medicine, University of Modena, 41126 Modena, Italy
Giovanni Targher, Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, 37122 Verona, Italy
Author contributions: All authors contributed to the manuscript.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Fabio Nascimbeni, MD, PhD, Division of Internal Medicine and Metabolism, Nuovo Ospedale Civile Sant'Agostino Estense - Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia and Azienda Ospedaliera of Modena, Via Giardini 1355, 41126 Modena, Italy. fabio.nascimbeni@libero.it
Telephone: +39-59-3961805 Fax: +39-59-3961323
Received: August 9, 2016
Peer-review started: August 9, 2016
First decision: August 29, 2016
Revised: September 29, 2016
Accepted: October 30, 2016
Article in press: October 31, 2016
Published online: November 28, 2016
Processing time: 109 Days and 13.7 Hours
Abstract

Fatty liver, which frequently coexists with necro-inflammatory and fibrotic changes, may occur in the setting of nonalcoholic fatty liver disease (NAFLD) and chronic infections due to either hepatitis C virus (HCV) or human immunodeficiency virus (HIV). These three pathologic conditions are associated with an increased prevalence and incidence of cardiovascular disease (CVD) and type 2 diabetes (T2D). In this multidisciplinary clinical review, we aim to discuss the ever-expanding wealth of clinical and epidemiological evidence supporting a key role of fatty liver in the development of T2D and CVD in patients with NAFLD and in those with HCV or HIV infections. For each of these three common diseases, the epidemiological features, pathophysiologic mechanisms and clinical implications of the presence of fatty liver in predicting the risk of incident T2D and CVD are examined in depth. Collectively, the data discussed in this updated review, which follows an innovative comparative approach, further reinforce the conclusion that the presence of fatty/inflamed/fibrotic liver might be a shared important determinant for the development of T2D and CVD in patients with NAFLD, HCV or HIV. This review may also open new avenues in the clinical and research arenas and paves the way for the planning of future, well-designed prospective and intervention studies.

Keywords: Atherosclerosis; Cardiovascular risk; Fatty liver; Fibrosis; Hepatitis C-associated dysmetabolic syndrome; Hepatitis C virus; Human immunodeficiency virus; Nonalcoholic fatty liver disease; Steatohepatitis; Steatosis; Virus-associated fatty liver disease

Core tip: Normally, the liver is almost devoid of fat and fatty changes often coexist with necro-inflammatory and fibrotic changes in the setting of nonalcoholic fatty liver disease (NAFLD), chronic infection due to hepatitis C virus (HCV) or human immunodeficiency virus (HIV), which have all been associated with an increased prevalence and incidence of cardiovascular disease (CVD) and type 2 diabetes (T2D). On these grounds, in this multidisciplinary clinical review, we discuss the ever-expanding wealth of evidence supporting a key role of fatty liver in the development of T2D and CVD both in patients with NAFLD and in those with HCV or HIV infections.