RELATIONSHIP BETWEEN TYPE 2 DIABETES MELLITUS (T2DM), INSULIN RESISTANCE (IR) AND NON-ALCOHOLIC FATTY LIVER DISEASE (NAFLD)

Abstract

The field of non-alcoholic fatty liver disease (NAFLD) and its progressive form, non-alcoholic steatohepatitis (NASH), despite the challenges posed by the coronavirus disease 2019 (COVID-19) pandemic, continued to evolve rapidly in 2020. NAFLD has been proposed to become metabolically associated fatty liver disease (MAFLD), 1 but the definition and terminology for clinical practice and clinical research require further discussion and consensus. Nonalcoholic fatty liver disease and its subtype nonalcoholic steatohepatitis affect approximately 30% and 5% of the US population, respectively. In patients with non-alcoholic steatohepatitis, half of the deaths are due to cardiovascular disease and malignancy, but awareness remains low. Cirrhosis, the third leading cause of death in patients with nonalcoholic fatty liver disease, is expected to become the most common indication for liver transplantation. Sixty-six percent of patients over 50 years of age with diabetes or obesity are thought to have nonalcoholic steatohepatitis with advanced fibrosis. Although the ability to identify the subtype of nonalcoholic steatohepatitis in patients with nonalcoholic fatty liver disease still requires liver biopsy, biomarkers for detecting progressive fibrosis are becoming increasingly reliable. Lifestyle modification is the mainstay of treatment for patients with nonalcoholic steatosis. The association between nonalcoholic steatohepatitis and cardiovascular disease is clear, although causality remains to be proven in well-controlled prospective studies. The incidence of hepatocellular carcinoma associated with nonalcoholic fatty liver disease is increasing, and up to 50% of cases may occur in the absence of cirrhosis