<scp>NAFLD</scp>in type 2 diabetes mellitus: Still many challenging questions

Cernea, Simona; Raz, Itamar

doi:10.1002/dmrr.3386

Cited by 21 publications

(23 citation statements)

References 159 publications

(328 reference statements)

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“…NAFLD can progress to hepatic inflammation and fibrosis (non-alcoholic steatohepatitis, NASH). The prevalence of NAFLD and its progression to NASH is about double in patients with T2DM than in non-diabetic individuals (Cernea and Raz, 2020).…”

Section: Adiposity Ectopic Fat Deposition Inflammation and Insulin Re...mentioning

confidence: 99%

Tolerable upper intake level for dietary sugars

Turck¹,

Bohn²,

Castenmiller³

et al. 2022

EFS2

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Following a request from five European Nordic countries, the EFSA Panel on Nutrition, Novel Foods and Food Allergens (NDA) was tasked to provide scientific advice on a tolerable upper intake level (UL) or a safe level of intake for dietary (total/added/free) sugars based on available data on chronic metabolic diseases, pregnancy‐related endpoints and dental caries. Specific sugar types (fructose) and sources of sugars were also addressed. The intake of dietary sugars is a well‐established hazard in relation to dental caries in humans. Based on a systematic review of the literature, prospective cohort studies do not support a positive relationship between the intake of dietary sugars, in isocaloric exchange with other macronutrients, and any of the chronic metabolic diseases or pregnancy‐related endpoints assessed. Based on randomised control trials on surrogate disease endpoints, there is evidence for a positive and causal relationship between the intake of added/free sugars and risk of some chronic metabolic diseases: The level of certainty is moderate for obesity and dyslipidaemia (> 50–75% probability), low for non‐alcoholic fatty liver disease and type 2 diabetes (> 15–50% probability) and very low for hypertension (0–15% probability). Health effects of added vs. free sugars could not be compared. A level of sugars intake at which the risk of dental caries/chronic metabolic diseases is not increased could not be identified over the range of observed intakes, and thus, a UL or a safe level of intake could not be set. Based on available data and related uncertainties, the intake of added and free sugars should be as low as possible in the context of a nutritionally adequate diet. Decreasing the intake of added and free sugars would decrease the intake of total sugars to a similar extent. This opinion can assist EU Member States in setting national goals/recommendations.

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Section: Adiposity Ectopic Fat Deposition Inflammation and Insulin Re...mentioning

confidence: 99%

Tolerable upper intake level for dietary sugars

Turck¹,

Bohn²,

Castenmiller³

et al. 2022

EFS2

View full text Add to dashboard Cite

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“…NAFLD affects various regulatory pathways and extra‐hepatic organs, and increases the risk of T2DM and CVD, CKD. However, a direct causal relationship has not been clearly delineated, nor the prognostic value of NAFLD for risk stratification, nor if reversing NAFLD also reverses CVD, CKD, or T2DM 8,9 …”

Section: Introductionmentioning

confidence: 99%

Serum creatinine levels and risk of nonalcohol fatty liver disease in a middle‐aged and older Chinese population: A cross‐sectional analysis

Niu

Zhang

et al. 2021

Diabetes Metabolism Res

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Background: Non-alcoholic fatty liver disease (NAFLD) is now regarded as the hepatic manifestation of metabolic syndrome (MetS). Recent research has suggested that serum creatinine (SCr) may be an indicator of MetS and its related diseases. We aimed to investigate the association between SCr and NAFLD in Chinese adults. Methods: A cross-sectional sample of 8862 subjects aged 40 years or older (40-73 years) from China were analysed in this study. The anthropometric measurements, laboratory tests, and hepatic ultrasonography were conducted. NAFLD presence was defined by hepatic ultrasound in the absence of other liver diseases.Results: NAFLD subjects had higher SCr than those without NAFLD (66.8 μmol/L vs. 65.6 μmol/L, p < 0.001). Moreover, SCr levels were correlated with alanine aminotransferase (β = 0.099, p < 0.001), aspartate aminotransferase (β = 0.135, p < 0.001), γ-glutamyltransferase (β = 0.039, p < 0.001), and insulin resistance (β = 0.027, p = 0.014) after adjusted for potential covariates. In the multivariableadjusted logistic regression analyses, compared to the first SCr quintile, the odds ratio for NAFLD was 1.35 (95% confidence interval 1.14-1.60, p < 0.001) for the fifth quintile after adjusting multiple measured confounders. Conclusion:SCr concentration is independently associated with NAFLD in a middle aged and older Chinese population. Elevated SCr levels, even within normal ranges, were associated with higher risk of NAFLD.

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“…But knowledge of advanced fibrosis may spur more intensive weight loss efforts, which can lead to reductions in fibrosis and improved outcomes 61–63 . Application of FIB‐4 or NFS scoring in primary care, especially in patients with type 2 diabetes, could prompt further testing or diagnostic assignment in those without a known liver disease diagnosis 22 …”

Section: Resultsmentioning

confidence: 99%

“…Despite the close relationship to these primary care conditions, NAFLD is underdiagnosed in primary care 11–16 . Broad screening recommendations for at‐risk patients are conflicting, but multiple guidelines address the importance of NAFLD detection in patients with abnormal liver tests (with NAFLD the most common cause of aminotransferase abnormality) and those with diabetes 1,5,17–22 …”

Section: Introductionmentioning

confidence: 99%

Advanced liver fibrosis and the metabolic syndrome in a primary care setting

Schreiner

Zhang

Durkalski‐Mauldin

et al. 2021

Diabetes Metabolism Res

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Aims The fibrosis‐4 index (FIB‐4) and NAFLD fibrosis score (NFS) are noninvasive and accessible methods for assessing advanced liver fibrosis risk in primary care. We evaluated the distribution of FIB‐4 and NFS scores in primary care patients with clinical signals for nonalcoholic fatty liver disease (NAFLD). Materials and Methods This retrospective cohort study of electronic record data between 2007 and 2018 included adults with at least one abnormal aminotransferase and no known (non‐NAFLD) liver disease. We calculated patient‐level FIB‐4 and NFS scores, the proportion of patients with mean values exceeding advanced fibrosis thresholds (indeterminate risk: FIB‐4 > 1.3, NFS > −1.455; high‐risk: FIB‐4 > 2.67, NFS > 0.676), and the proportion of patients with a NAFLD International Classification of Diseases‐9/10 code. Logistic regression models evaluated the associations of metabolic syndrome (MetS) components with elevated FIB‐4 and NFS scores. Results The cohort included 6506 patients with a median of 6 (interquartile range: 3–13) FIB‐4 and NFS scores per patient. Of these patients, 81% had at least two components of MetS, 29% had mean FIB‐4 and NFS scores for indeterminate fibrosis risk, and 11% had either mean FIB‐4 or NFS scores exceeding the high advanced fibrosis risk thresholds. Regression models identified associations of low high‐density lipoprotein, hyperglycemia, Black race and male gender with high‐risk FIB‐4 and NFS values. Only 5% of patients had existing diagnoses for NAFLD identified. Conclusions Many primary care patients have FIB‐4 and NFS scores concerning for advanced fibrosis, but rarely a diagnosis of NAFLD. Elevated FIB‐4 and NFS scores may provide signals for further clinical evaluation of liver disease in primary care settings.

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NAFLDin type 2 diabetes mellitus: Still many challenging questions

Cited by 21 publications

References 159 publications

Tolerable upper intake level for dietary sugars

Tolerable upper intake level for dietary sugars

Serum creatinine levels and risk of nonalcohol fatty liver disease in a middle‐aged and older Chinese population: A cross‐sectional analysis

Advanced liver fibrosis and the metabolic syndrome in a primary care setting

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