Review
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Sep 15, 2022; 13(9): 668-682
Published online Sep 15, 2022. doi: 10.4239/wjd.v13.i9.668
Nonalcoholic fatty liver disease and diabetes
Maria Irene Bellini, Irene Urciuoli, Giovanni Del Gaudio, Giorgia Polti, Giovanni Iannetti, Elena Gangitano, Eleonora Lori, Carla Lubrano, Vito Cantisani, Salvatore Sorrenti, Vito D’Andrea
Maria Irene Bellini, Irene Urciuoli, Eleonora Lori, Salvatore Sorrenti, Vito D’Andrea, Department of Surgical Sciences, Sapienza University of Rome, Rome 00161, Italy
Giovanni Del Gaudio, Giorgia Polti, Giovanni Iannetti, Vito Cantisani, Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Rome 00161, Italy
Elena Gangitano, Carla Lubrano, Department of Experimental Medicine, Section of Medical Physiopathology, Food Science and Endocrinology, Sapienza University of Rome, Rome 00161, Italy
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Maria Irene Bellini, FEBS, MD, PhD, Assistant Professor, Surgeon, Department of Surgical Sciences, Sapienza University of Rome, Viale Regina Elena, Rome 00161, Italy. mariairene.bellini@uniroma1.it
Received: March 30, 2022
Peer-review started: March 30, 2022
First decision: April 25, 2022
Revised: May 3, 2022
Accepted: August 6, 2022
Article in press: August 6, 2022
Published online: September 15, 2022
Processing time: 163 Days and 2.9 Hours
Abstract

Nonalcoholic fatty liver disease (NAFLD) is the most prevalent chronic liver disease in the world and represents a clinical-histopathologic entity where the steatosis component may vary in degree and may or may not have fibrotic progression. The key concept of NAFLD pathogenesis is excessive triglyceride hepatic accumulation because of an imbalance between free fatty acid influx and efflux. Strong epidemiological, biochemical, and therapeutic evidence supports the premise that the primary pathophysiological derangement in most patients with NAFLD is insulin resistance; thus the association between diabetes and NAFLD is widely recognized in the literature. Since NAFLD is the hepatic manifestation of a metabolic disease, it is also associated with a higher cardio-vascular risk. Conventional B-mode ultrasound is widely adopted as a first-line imaging modality for hepatic steatosis, although magnetic resonance imaging represents the gold standard noninvasive modality for quantifying the amount of fat in these patients. Treatment of NAFLD patients depends on the disease severity, ranging from a more benign condition of nonalcoholic fatty liver to nonalcoholic steatohepatitis. Abstinence from alcohol, a Mediterranean diet, and modification of risk factors are recommended for patients suffering from NAFLD to avoid major cardiovascular events, as per all diabetic patients. In addition, weight loss induced by bariatric surgery seems to also be effective in improving liver features, together with the benefits for diabetes control or resolution, dyslipidemia, and hypertension. Finally, liver transplantation represents the ultimate treatment for severe nonalcoholic fatty liver disease and is growing rapidly as a main indication in Western countries. This review offers a comprehensive multidisciplinary approach to NAFLD, highlighting its connection with diabetes.

Keywords: Bariatric surgery; Diabetes; Hepatic steatosis; Liver fibrosis; Nonalcoholic fatty liver disease; Nonalcoholic steatohepatitis

Core Tip: Nonalcoholic fatty liver disease is the most common liver disease worldwide, characterized by fat accumulation in the hepatic parenchyma, with a range of different stages from mild inflammation to severe fibrosis. There is a biunivocal relationship with type 2 diabetes, with important consequences in terms of cardiovascular risk, which seems to also have occurred during the coronavirus disease 2019 pandemic. This review focuses on the pathogenesis, clinical aspects, and treatment, providing guidance for a non-invasive diagnosis and preferred therapy, medical and/or surgical.