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Non-alcoholic fatty liver disease: a diabetologist’s perspective

Endocrine volume 45, pages 344–353 (2014)Cite this article

Abstract

In the recent years, non-alcoholic fatty liver disease (NAFLD) has emerged as the commonest cause of chronic liver disease in the developed world. The global epidemic of obesity secondary to physical inactivity and adverse food habits accounts for the alarming rise in NAFLD. Metabolic syndrome plays a major role in the pathogenesis of both NAFLD and type 2 diabetes mellitus (T2DM). Whilst most cases of NAFLD remain asymptomatic with only hepatic steatosis, about 30 % progress to non-alcoholic steatohepatitis with chronic liver inflammation that can lead on to fibrosis, cirrhosis, liver failure, and hepatocellular carcinoma. Because of the similar pathogenesis shared between T2DM and NAFLD, T2DM occurs as an important complication in many cases of NAFLD, and many cases of T2DM are further complicated by NAFLD. Rapid progression and increased complications of the individual diseases is the end result of this dual coexistence. Diagnosis of NAFLD relies upon hepatic imaging, serum biochemical markers, and liver biopsy. As in T2DM, the most important management option for patients with NAFLD is lifestyle changes targeted at weight reduction. Other treatment options include insulin sensitizers (metformin and pioglitazone), vitamin E, incretin mimetics, omega-3 fatty acids, cholesterol lowering agents, orlistat, and bariatric surgery. The clinical spectrum, patho-physiological features and therapeutic options of NAFLD share many things in common with T2DM and therefore, this review is to highlight the diabetologist’s perspective of the disease.

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References

  1. P. Angulo, GI epidemiology: non-alcoholic fatty liver disease. Aliment. Pharmacol. Ther. 25, 883–889 (2007)

    CAS  PubMed  Article  Google Scholar 

  2. M.M. Finucane, G.A. Stevens, M.J. Cowan, G. Danaei, J.K. Lin, C.J. Paciorek et al., National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9.1 million participants. Lancet. 377(9765), 557–567 (1980). (2011)

    Article  Google Scholar 

  3. M.J. Pappachan, Increasing prevalence of lifestyle diseases: high time for action. Indian J. Med. Res. 134, 143–145 (2011)

    CAS  PubMed Central  PubMed  Google Scholar 

  4. S. Bellentani, M. Marino, Epidemiology and natural history of non-alcoholic fatty liver disease (NAFLD). Ann. Hepatol. 8(Suppl 1), S4–S8 (2009)

    PubMed  Google Scholar 

  5. N. Chalasani, Z. Younossi, J.E. Lavine, A.M. Diehl, E.M. Brunt, K. Cusi et al., The diagnosis and management of non-alcoholic fatty liver disease: practice Guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association. Hepatology 55, 2005–2023 (2012)

    PubMed  Article  Google Scholar 

  6. B. Krishnan, S. Babu, J. Walker, A.B. Walker, J.M. Pappachan, Gastrointestinal complications of diabetes mellitus. World J. Diabetes 4, 51–63 (2013)

    PubMed Central  PubMed  Article  Google Scholar 

  7. C.M. Leevy, Fatty liver: a study of 270 patients with biopsy proven fatty liver and review of the literature. Medicine 41, 249–276 (1962)

    CAS  PubMed  Article  Google Scholar 

  8. J. Ludwig, T.R. Viggiano, D.B. McGill, Nonalcoholic steatohepatitis: Mayo Clinic experiences with a hitherto unnamed disease. Mayo Clin. Proc. 55, 434–438 (1980)

    CAS  PubMed  Google Scholar 

  9. H. Lu, H. Liu, F. Hu, L. Zou, S. Luo, L. Sun, Independent Association between nonalcoholic fatty liver disease and cardiovascular disease: a systematic review and meta-analysis. Int. J. Endocrinol. 2013, 124958 (2013)

    PubMed Central  PubMed  Article  Google Scholar 

  10. C. Flannery, S. Dufour, R. Rabøl, G.I. Shulman, K.F. Petersen, Skeletal muscle insulin resistance promotes increased hepatic de novo lipogenesis, hyperlipidemia, and hepatic steatosis in the elderly. Diabetes 61, 2711–2717 (2012)

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  11. G. Targher, C.D. Byrne, Clinical Review: nonalcoholic fatty liver disease: a novel cardiometabolic risk factor for type 2 diabetes and its complications. J. Clin. Endocrinol. Metab. 98, 483–495 (2013)

    CAS  PubMed  Article  Google Scholar 

  12. E. Scorletti, P.C. Calder, C.D. Byrne, Non-alcoholic fatty liver disease and cardiovascular risk: metabolic aspects and novel treatments. Endocrine 40, 332–343 (2011)

    CAS  PubMed  Article  Google Scholar 

  13. K.G. Alberti, P. Zimmet, J. Shaw, Metabolic syndrome–a new world-wide definition. A Consensus Statement from the International Diabetes Federation. Diabetes Med. 23, 469–480 (2006)

    CAS  Article  Google Scholar 

  14. A.B. Ross, J.P. Godin, K. Minehira, J.P. Kirwan, Increasing whole grain intake as part of prevention and treatment of nonalcoholic Fatty liver disease. Int. J. Endocrinol. 2013, 585876 (2013)

    PubMed Central  PubMed  Article  Google Scholar 

  15. D.N. Amarapurkar, E. Hashimoto, L.A. Lesmana, J.D. Sollano, P.J. Chen, K.L. Goh, How common is non-alcoholic fatty liver disease in the Asia-Pacific region and are there local differences? J. Gastroenterol. Hepatol. 22, 788–793 (2007)

    PubMed  Article  Google Scholar 

  16. J.D. Browning, L.S. Szczepaniak, R. Dobbins, P. Nuremberg, J.D. Horton, J.C. Cohen et al., Prevalence of hepatic steatosis in an urban population in the United States: impact of ethnicity. Hepatology 40, 1387–1395 (2004)

    PubMed  Article  Google Scholar 

  17. P. Paschos, K. Paletas, Non alcoholic fatty liver disease and metabolic syndrome. Hippokratia 13, 9–19 (2009)

    CAS  PubMed Central  PubMed  Google Scholar 

  18. M.C. Brindisi, B. Guiu, L. Duvillard, A. Athias, F. Rollot, B. Bouillet et al., Liver fat content is associated with an increase in cholesterol synthesis independent of statin therapy use in patients with type 2 diabetes. Atherosclerosis 224, 465–468 (2012)

    CAS  PubMed  Article  Google Scholar 

  19. A. Kotronen, L. Juurinen, M. Tiikkainen, S. Vehkavaara, H. Yki-Järvinen, Increased liver fat, impaired insulin clearance, and hepatic and adipose tissue insulin resistance in type 2 diabetes. Gastroenterology 135, 122–130 (2008)

    CAS  PubMed  Article  Google Scholar 

  20. C.P. Day, O.F. James, Steatohepatitis: a tale of two “hits”? Gastroenterology 114, 842–845 (1998)

    CAS  PubMed  Article  Google Scholar 

  21. H. Tilg, A.R. Moschen, Evolution of inflammation in nonalcoholic fatty liver disease: the multiple parallel hits hypothesis. Hepatology 52, 1836–1846 (2010)

    CAS  PubMed  Article  Google Scholar 

  22. A. Kotronen, L. Juurinen, M. Tiikkainen, S. Vehkavaara, H. Yki-Järvinen, Increased liver fat, impaired insulin clearance, and hepatic and adipose tissue insulin resistance in type 2 diabetes. Gastroenterology 135, 122–130 (2008)

    CAS  PubMed  Article  Google Scholar 

  23. H. Rodríguez-Hernández, L.E. Simental-Mendía, G. Rodríguez-Ramírez, M.A. Reyes-Romero, Obesity and inflammation: epidemiology, risk factors, and markers of inflammation. Int. J. Endocrinol. 2013, 678159 (2013)

    PubMed Central  PubMed  Article  Google Scholar 

  24. O. James, C. Day, Non-alcoholic steatohepatitis: another disease of affluence. Lancet 353, 1634–1636 (1999)

    CAS  PubMed  Article  Google Scholar 

  25. P. Loria, A. Lonardo, F. Anania, Liver and diabetes: a vicious circle. Hepatol. Res. 43, 51–64 (2013)

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  26. E.M. Brunt, Nonalcoholic steatohepatitis: definition and pathology. Semin. Liver Dis. 21, 3–16 (2001)

    CAS  PubMed  Article  Google Scholar 

  27. L. Abenavoli, N. Milic, A. De Lorenzo, F. Luzza, A pathogenetic link between non-alcoholic fatty liver disease and celiac disease. Endocrine 43, 65–67 (2013)

    CAS  PubMed  Article  Google Scholar 

  28. M. Civera, A. Urios, M.L. Garcia-Torres, J. Ortega, J. Martinez-Valls, N. Cassinello et al., Relationship between insulin resistance, inflammation and liver cell apoptosis in patients with severe obesity. Diabetes Metab. Res. Rev. 26, 187–192 (2010)

    CAS  PubMed  Article  Google Scholar 

  29. V. Ratziu, S. Bellentani, H. Cortez-Pinto, C. Day, G. Marchesini, A position statement on NAFLD/NASH based on the EASL 2009 special conference. J. Hepatol. 53, 372–384 (2010)

    PubMed  Article  Google Scholar 

  30. H. Kang, J.K. Greenson, J.T. Omo, C. Chao, D. Peterman, L. Anderson et al., Metabolic syndrome is associated with greater histologic severity, higher carbohydrate, and lower fat diet in patients with NAFLD. Am. J. Gastroenterol. 101, 2247–2253 (2006)

    CAS  PubMed  Article  Google Scholar 

  31. M.C. Ryan, A.M. Wilson, J. Slavin, J.D. Best, A.J. Jenkins, P.V. Desmond, Associations between liver histology and severity of the metabolic syndrome in subjects with nonalcoholic fatty liver disease. Diabetes Care 28, 1222–1224 (2005)

    PubMed  Article  Google Scholar 

  32. B.A. Neuschwander-Tetri, J.M. Clark, N.M. Bass, M.L. Van Natta, A. Unalp-Arida, J. Tonascia et al., Clinical, laboratory and histological associations in adults with nonalcoholic fatty liver disease. Hepatology 52, 913–924 (2010)

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  33. N. Baršić, I. Lerotić, L. Smirčić-Duvnjak, V. Tomašić, M. Duvnjak, Overview and developments in noninvasive diagnosis of nonalcoholic fatty liver disease. World J. Gastroenterol. 18, 3945–3954 (2012)

    PubMed Central  PubMed  Article  Google Scholar 

  34. M. Obika, H. Noguchi, Diagnosis and evaluation of nonalcoholic fatty liver disease. Exp. Diabetes Res. 2012, 145754 (2012)

    PubMed Central  PubMed  Article  Google Scholar 

  35. L.A. Adams, P. Angulo, Role of liver biopsy and serum markers of liver fibrosis in non-alcoholic fatty liver disease. Clin. Liver Dis. 11, 25–35 (2007). viii

    PubMed  Article  Google Scholar 

  36. P. Angulo, J.C. Keach, K.P. Batts, K.D. Lindor, Independent predictors of liver fibrosis in patients with nonalcoholic steatohepatitis. Hepatology 30, 1356–1362 (1999)

    CAS  PubMed  Article  Google Scholar 

  37. P. Sorrentino, G. Tarantino, P. Conca, A. Perrella, M.L. Terracciano, R. Vecchione et al., Silent non-alcoholic fatty liver disease-a clinical-histological study. J. Hepatol. 41, 751–757 (2004)

    CAS  PubMed  Article  Google Scholar 

  38. H. Osawa, Y. Mori, Sonographic diagnosis of fatty liver using a histogram technique that compares liver and renal cortical echo amplitudes. J. Clin. Ultrasound 24, 25–29 (1996)

    CAS  PubMed  Article  Google Scholar 

  39. S.M. Mazhar, M. Shiehmorteza, C.B. Sirlin, Noninvasive assessment of hepatic steatosis. Clin. Gastroenterol. Hepatol. 7, 135–140 (2009)

    PubMed  Article  Google Scholar 

  40. M. Fishbein, F. Castro, S. Cheruku, S. Jain, B. Webb, T. Gleason, W.R. Stevens, Hepatic MRI for fat quantitation: its relationship to fat morphology, diagnosis, and ultrasound. J. Clin. Gastroenterol. 39, 619–625 (2005)

    PubMed  Article  Google Scholar 

  41. R. Longo, P. Pollesello, C. Ricci, F. Masutti, B.J. Kvam, L. Bercich et al., Proton MR spectroscopy in quantitative in vivo determination of fat content in human liver steatosis. J. Magn. Reson. Imaging 5, 281–285 (1995)

    CAS  PubMed  Article  Google Scholar 

  42. S. Saadeh, Z.M. Younossi, E.M. Remer, T. Gramlich, J.P. Ong, M. Hurley et al., The utility of radiological imaging in nonalcoholic fatty liver disease. Gastroenterology 123, 745–750 (2002)

    PubMed  Article  Google Scholar 

  43. V.W.S. Wong, J. Vergniol, G.L. Wong, J. Foucher, H.L. Chan, B. Le Bail et al., Diagnosis of fibrosis and cirrhosis using liver stiffness measurement in nonalcoholic fatty liver disease. Hepatology 51, 454–462 (2010)

    CAS  PubMed  Article  Google Scholar 

  44. L. Abenavoli, M. Beaugrand, Transient elastography in non-alcoholic fatty liver disease. Ann. Hepatol. 11, 172–178 (2012)

    PubMed  Google Scholar 

  45. M. Obika, H. Noguchi, Diagnosis and evaluation of nonalcoholic fatty liver disease. Exp. Diabetes Res. 2012, 145754 (2012)

    PubMed Central  PubMed  Article  Google Scholar 

  46. G. Musso, R. Gambino, M. Cassader, G. Pagano, Meta-analysis: natural history of non-alcoholic fatty liver disease (NAFLD) and diagnostic accuracy of non-invasive tests for liver disease severity. Ann. Med. 43, 617–649 (2011)

    PubMed  Article  Google Scholar 

  47. E.M. Brunt, D.E. Kleiner, L.A. Wilson, P. Belt, B.A. Neuschwander-Tetri, NASH Clinical Research Network (CRN). The NAS and the histopathologic diagnosis in NAFLD: distinct clinicopathologic meanings. Hepatology 53, 810–820 (2011)

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  48. L.A. Adams, S. Sanderson, K.D. Lindor, P. Angulo, The histological course of nonalcoholic fatty liver disease: a longitudinal study of 103 patients with sequential liver biopsies. J. Hepatol. 42, 132–138 (2005)

    PubMed  Article  Google Scholar 

  49. J.H. Choi, E.J. Rhee, J.C. Bae, S.E. Park, C.Y. Park, Y.K. Cho et al., Increased risk of type 2 diabetes in subjects with both elevated liver enzymes and ultrasonographically diagnosed nonalcoholic fatty liver disease: a 4-year longitudinal study. Arch. Med. Res. 44, 115–120 (2013)

    CAS  PubMed  Article  Google Scholar 

  50. M. Ekstedt, L.E. Franzén, U.L. Mathiesen, L. Thorelius, M. Holmqvist, G. Bodemar, S. Kechagias, Long-term follow-up of patients with NAFLD and elevated liver enzymes. Hepatology 44, 865–873 (2006)

    CAS  PubMed  Article  Google Scholar 

  51. Y. Colak, E. Senates, A. Yesil, Y. Yilmaz, O. Ozturk, L. Doganay et al., Assessment of endothelial function in patients with nonalcoholic fatty liver disease. Endocrine 43, 100–107 (2013)

    CAS  PubMed  Article  Google Scholar 

  52. A. Suzuki, K. Lindor, J. St Saver, J. Lymp, F. Mendes, A. Muto et al., Effect of changes on body weight and lifestyle in nonalcoholic fatty liver disease. J. Hepatol. 43, 1060–1066 (2005)

    CAS  PubMed  Article  Google Scholar 

  53. J.A. Davila, R.O. Morgan, Y. Shaib, K.A. McGlynn, H.B. El-Serag, Diabetes increases the risk of hepatocellular carcinoma in the United States: a population based case control study. Gut 54, 533–539 (2005)

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  54. M.S. Siddiqui, R.K. Sterling, Posttransplant metabolic syndrome. Int. J. Hepatol. 2012, 891516 (2012)

    PubMed Central  PubMed  Article  Google Scholar 

  55. M.J. Contos, W. Cales, R.K. Sterling, V.A. Luketic, M.L. Shiffman, A.S. Mills et al., Development of nonalcoholic fatty liver disease after orthotopic liver transplantation for cryptogenic cirrhosis. Liver Transpl. 7, 363–373 (2001)

    CAS  PubMed  Article  Google Scholar 

  56. L.G. Lim, C.L. Cheng, A. Wee, S.G. Lim, Y.M. Lee, D.S. Sutedja et al., Prevalence and clinical associations of posttransplant fatty liver disease. Liver Int. 27, 76–80 (2007)

    PubMed  Article  Google Scholar 

  57. L.A. Adams, J.F. Lymp, J. St Sauver, S.O. Sanderson, K.D. Lindor, A. Feldstein, P. Angulo, The natural history of nonalcoholic fatty liver disease: a population-based cohort study. Gastroenterology 129, 113–121 (2005)

    PubMed  Article  Google Scholar 

  58. A. Fraser, R. Harris, N. Sattar, S. Ebrahim, G. Davey Smith, D.A. Lawlor, Alanine aminotransferase, gamma-glutamyltransferase, and incident diabetes: the British Women’s Heart and Health Study and meta-analysis. Diabetes Care 32, 741–750 (2009)

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  59. C. Sreenivasa Baba, G. Alexander, B. Kalyani, R. Pandey, S. Rastogi, A. Pandey, G. Choudhuri, Effect of exercise and dietary modification on serum aminotransferase levels in patients with nonalcoholic steatohepatitis. J. Gastroenterol. Hepatol. 21, 191–198 (2006)

    PubMed  Article  Google Scholar 

  60. I.J. Hickman, J.R. Jonsson, J.B. Prins, S. Ash, D.M. Purdie, A.D. Clouston et al., Modest weight loss and physical activity in overweight patients with chronic liver disease results in sustained improvements in alanine aminotransferase, fasting insulin, and quality of life. Gut 53, 413–419 (2004)

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  61. K. Promrat, D.E. Kleiner, H.M. Niemeier, E. Jackvony, M. Kearns, J.R. Wands et al., Randomized controlled trial testing the effects of weight loss on nonalcoholic steatohepatitis. Hepatology 51, 121–129 (2010)

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  62. K. Hallsworth, G. Fattakhova, K.G. Hollingsworth, C. Thoma, S. Moore, R. Taylor et al., Resistance exercise reduces liver fat and its mediators innon-alcoholic fatty liver diseaseindependent of weight loss. Gut 60, 1278–1283 (2011)

    PubMed Central  PubMed  Article  Google Scholar 

  63. B.A. Gordon, A.C. Benson, S.R. Bird, S.F. Fraser, Resistance training improves metabolic health in type 2 diabetes: a systematic review. Diabetes Res. Clin. Pract. 83, 157–175 (2009)

    CAS  PubMed  Article  Google Scholar 

  64. J.D. Browning, J.A. Baker, T. Rogers, J. Davis, S. Satapati, S.C. Burgess, Short-term weight loss and hepatic triglyceride reduction: evidence of a metabolic advantage with dietary carbohydrate restriction. Am. J. Clin. Nutr. 93, 1048–1052 (2011)

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  65. J.E. Lavine, J.B. Schwimmer, M.L. Van Natta, J.P. Molleston, K.F. Murray, P. Rosenthal et al., Effect of vitamin E or metformin for treatment of nonalcoholic fatty liver disease in children and adolescents: the TONIC randomized controlled trial. JAMA 305, 1659–1668 (2011)

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  66. G. Musso, M. Cassader, F. Rosina, R. Gambino, Impact of current treatments on liver disease, glucose metabolism and cardiovascular risk in non-alcoholic fatty liver disease (NAFLD): a systematic review and meta-analysis of randomised trials. Diabetologia 55, 885–904 (2012)

    CAS  PubMed  Article  Google Scholar 

  67. A.J. Sanyal, N. Chalasani, K.V. Kowdley, A. McCullough, A.M. Diehl, N.M. Bass et al., Pioglitazone, vitamin E, or placebo for nonalcoholic steatohepatitis. N. Engl. J. Med. 362, 1675–1685 (2010)

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  68. L. Abenavoli, N. Milic, F. Capasso, Anti-oxidant therapy in non-alcoholic fatty liver disease: the role of silymarin. Endocrine 42, 754–755 (2012)

    CAS  PubMed  Article  Google Scholar 

  69. T. Vilsbøll, M. Christensen, A.E. Junker, F.K. Knop, L.L. Gluud, Effects of glucagon-like peptide-1 receptor agonists on weight loss: systematic review and meta-analyses of randomised controlled trials. BMJ 344, d7771 (2012)

    PubMed Central  PubMed  Article  Google Scholar 

  70. D.J. Cuthbertson, A. Irwin, C.J. Gardner, C. Daousi, T. Purewal, N. Furlong et al., Improved glycaemia correlates with liver fat reduction in obese, type 2 diabetes, patients givenglucagon-like peptide-1 (GLP-1) receptor agonists. PLoS One 7, e50117 (2012)

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  71. Y. Yilmaz, O. Atug, O. Yonal, D. Duman, O. Ozdogan, N. Imeryuz et al., Dipeptidyl peptidase IV inhibitors: therapeutic potential in nonalcoholic fatty liver disease. Med. Sci. Monit. 15, HY1–HY5 (2009)

    CAS  PubMed  Google Scholar 

  72. Y. Li, J. Hai, L. Li, X. Chen, H. Peng, M. Cao et al., Administration of ghrelin improves inflammation, oxidative stress, and apoptosis during and after non-alcoholic fatty liver disease development. Endocrine 43, 376–386 (2013)

    CAS  PubMed  Article  Google Scholar 

  73. P.J. Delhanty, A.J. van der Lely, Ghrelin: a new treatment for non-alcoholic fatty liver disease? Endocrine 43, 247–248 (2013)

    CAS  PubMed  Article  Google Scholar 

  74. H.M. Parker, N.A. Johnson, C.A. Burdon, J.S. Cohn, H.T. O’Connor, J. George, Omega-3 supplementation and non-alcoholic fatty liver disease: a systematic review and meta-analysis. J. Hepatol. 56, 944–951 (2012)

    CAS  PubMed  Article  Google Scholar 

  75. M.N. Di Minno, A. Russolillo, R. Lupoli, P. Ambrosino, A. Di Minno, G. Tarantino, Omega-3 fatty acids for the treatment of non-alcoholic fatty liver disease. World J. Gastroenterol. 18, 5839–5847 (2012)

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  76. N. Chalasani, Z. Younossi, J.E. Lavine, A.M. Diehl, E.M. Brunt, K. Cusi et al., The diagnosis and management of non-alcoholic fatty liver disease: practice Guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association. Hepatology 55, 2005–2023 (2012)

    PubMed  Article  Google Scholar 

  77. M.H. Ahmed, C.D. Byrne, Current treatment of non-alcoholic fatty liver disease. Diabetes Obes. Metab. 11, 188–195 (2009)

    CAS  PubMed  Article  Google Scholar 

  78. S. Fatani, I. Itua, P. Clark, C. Wong, E.K. Naderali, The effects of diet-induced obesity on hepatocyte insulin signaling pathways and induction of non-alcoholic liver damage. Int. J. Gen. Med. 4, 211–219 (2011)

    CAS  PubMed Central  PubMed  Google Scholar 

  79. H. Park, T. Shima, K. Yamaguchi, H. Mitsuyoshi, M. Minami, K. Yasui et al., Efficacy of long-term ezetimibe therapy in patients with nonalcoholic fatty liver disease. J. Gastroenterol. 46, 101–107 (2011)

    CAS  PubMed  Article  Google Scholar 

  80. V.G. Athyros, O. Giouleme, E.S. Ganotakis, M. Elisaf, K. Tziomalos, T. Vassiliadis et al., Safety and impact on cardiovascular events of long-term multifactorial treatment in patients with metabolic syndrome and abnormal liver function tests: a post hoc analysis of the randomised ATTEMPT study. Arch. Med. Sci. 7, 796–805 (2011)

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  81. T.D. Adams, L.E. Davidson, S.E. Litwin, R.L. Kolotkin, M.J. LaMonte, R.C. Pendleton et al., Health benefits of gastric bypass surgery after 6 years. JAMA 308, 1122–1131 (2012)

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  82. P. Mathurin, A. Hollebecque, L. Arnalsteen, D. Buob, E. Leteurtre, R. Caiazzo et al., Prospective study of the long-term effects of bariatric surgery on liver injury in patients without advanced disease. Gastroenterology 137, 532–540 (2009)

    CAS  PubMed  Article  Google Scholar 

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  1. Department of Endocrinology, Diabetes & Metabolism, University Hospital of North Staffordshire, Stoke-on-Trent, ST4 6QG, UK

    Joseph M. Pappachan, Farrah A. Antonio, Mahamood Edavalath & Arjun Mukherjee

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Correspondence to Joseph M. Pappachan.

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Pappachan, J.M., Antonio, F.A., Edavalath, M. et al. Non-alcoholic fatty liver disease: a diabetologist’s perspective. Endocrine 45, 344–353 (2014). https://doi.org/10.1007/s12020-013-0087-8

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Keywords

  • Non-alcoholic fatty liver disease (NAFLD)
  • Non-alcoholic steatohepatitis (NASH)
  • Cardiovascular disease (CVD)
  • Type 2 diabetes mellitus (T2DM)
  • Metabolic syndrome (MS)