Nonalcoholic fatty liver disease and chronic vascular complications of diabetes mellitus

Abstract

Nonalcoholic fatty liver disease (NAFLD) and diabetes mellitus are common diseases that often coexist and might act synergistically to increase the risk of hepatic and extra-hepatic clinical outcomes. NAFLD affects up to 70-80% of patients with type 2 diabetes mellitus and up to 30-40% of adults with type 1 diabetes mellitus. The coexistence of NAFLD and diabetes mellitus increases the risk of developing not only the more severe forms of NAFLD but also chronic vascular complications of diabetes mellitus. Indeed, substantial evidence links NAFLD with an increased risk of developing cardiovascular disease and other cardiac and arrhythmic complications in patients with type 1 diabetes mellitus or type 2 diabetes mellitus. NAFLD is also associated with an increased risk of developing microvascular diabetic complications, especially chronic kidney disease. This Review focuses on the strong association between NAFLD and the risk of chronic vascular complications in patients with type 1 diabetes mellitus or type 2 diabetes mellitus, thereby promoting an increased awareness of the extra-hepatic implications of this increasingly prevalent and burdensome liver disease. We also discuss the putative underlying mechanisms by which NAFLD contributes to vascular diseases, as well as the emerging role of changes in the gut microbiota (dysbiosis) in the pathogenesis of NAFLD and associated vascular diseases.

A diabetologist’s perspective of non‐alcoholic steatohepatitis (NASH): Knowledge gaps and future directions

“…Over the next 20 years, NASH in T2DM is projected to account for 29% of all liver transplants and 812,000 liver‐related deaths. Of note, the model did not include the potentially higher rates of diabetes‐related micro‐ and macrovascular complications associated with NASH . These findings should alarm diabetologists and prompt them to become proactive by viewing NASH as a common and serious complication of T2DM that should be systematically screened …”

“…Of note, the model did not include the potentially higher rates of diabetes-related micro-and macrovascular complications associated with NASH. 5 These findings should alarm diabetologists and prompt them to become proactive by viewing NASH as a common and serious complication of T2DM that should be systematically screened. 6 A step forward in the field of diabetes has been the 2019 Standard of Care guidelines by the American Diabetes Association that recommended that "patients with T2DM and elevated liver enzymes aminotransferase (ALT) or fatty liver on ultrasound should be evaluated for the presence of NASH and liver fibrosis" (Recommendation 4.14, page S40).…”

Hepatic steatosis in patients with acromegaly

“…2 In addition, common genetic variations in the membrane-bound O-acyltransferase domain-containing 7 (MBOAT7) and in the transmembrane 6 superfamily member 2 (TM6SF2) genes have also been associated with increased susceptibility to NAFLD and its severity. 5 Nondiabetic endocrinopathies are also increasingly being linked to fatty liver. 4 NAFLD has also been reported in up to 80% of patients with type 2 diabetes.…”

Oxymatrine ameliorates diabetes‐induced aortic endothelial dysfunction via the regulation of eNOS and NOX4

“…Diabetes mellitus is a serious health threat which can adversely affect multiple organs due to its long‐term complications . The mortality from cardiovascular complications in the diabetic population is approximately three to five folds higher than the general population . It has been reported that risk factors in diabetes, including insulin resistance, impairment of insulin‐induced whole‐body glucose uptake, dyslipidemia, and atherosclerosis induced oxidative stress could impair the endothelial function.…”