Download PDF
Exp Clin Endocrinol Diabetes 2022; 130(S 01): S113-S116
DOI: 10.1055/a-1624-3541
German Diabetes Association: Clinical Practice Guidelines

Diabetes and Fatty Liver

Norbert Stefan
1   German Centre for Diabetes Research (DZD), Germany
2   Heisenberg Professorship and Chair of Clinical Experimental Diabetology, Department of Internal Medicine IV, Endocrinology, Diabetology, and Nephrology, University Hospital, Tübingen, Germany
3   Department of Pathophysiology of Prediabetes of the Institute for Diabetes Research and Metabolic Diseases (IDM) of Helmholtz Centre Munich at the University of Tübingen, Germany
,
Michael Roden
1   German Centre for Diabetes Research (DZD), Germany
4   Division for Endocrinology and Diabetology, Medical Faculty of the Heinrich Heine University and University Hospital, Düsseldorf, Germany
5   Institute for Clinical Diabetology, German Diabetes Centre (DDZ), Leibniz Centre for Diabetes Research at the Heinrich Heine University, Düsseldorf, Germany
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

Introduction

Non-alcoholic fatty liver disease (NAFLD) affects more than 25% of the adult population worldwide. According to analyses for 2016, Germany ranks third behind Greece (41%) and Italy (25.4%) in the prevalence of NAFLD (22.9% of the total population). An increase in the prevalence of NAFLD to 26.4% has been calculated for Germany (2.3) for the year 2030. At around 70%, the frequency of NAFLD is particularly high in people with obesity and/or type 2 diabetes [2]. However, NAFLD also occurs in about 7% of lean people and is then primarily of genetic origin [2]. There is also preliminary evidence that therapy with checkpoint inhibitors, which is increasingly used in the context of cancer treatments, may induce NAFLD in lean individuals via subclinical inflammation of subcutaneous adipose tissue, which leads to, among other things, significant weight loss [3]. In Europe and the USA, NAFLD is now regarded as the most frequent cause of chronic liver diseases although most people with NAFLD die from secondary diseases resulting from diabetes or cardiovascular diseases. Therefore, it is particularly important to test patients with type 2 diabetes for the presence, and especially the degree of severity, of NAFLD, and to plan therapy accordingly [4] [5]. New research from the German Diabetes Study (GDS) indicates that especially the severely insulin-resistant diabetes subtype (cluster) has a significantly increased prevalence of NAFLD already in the year of diabetes diagnosis and shows a greater increase in surrogate markers of fibrosis in the first 5 years [6].



Publication History

Article published online:
01 April 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Younossi ZM, Koenig AB, Abdelatif D. et al. Global epidemiology of nonalcoholic fatty liver disease-Meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology 2016; 64: 73-84
    CrossrefPubMedGoogle Scholar
  • 2 Younossi ZM. Non-alcoholic fatty liver disease – A global public health perspective. J Hepatol 2019; 70: 531-544
    Google Scholar
  • 3 Eigentler T, Lomberg D, Machann J. et al. Lipodystrophic Nonalcoholic Fatty Liver Disease Induced by Immune Checkpoint Blockade. Ann Intern Med 2020; 172: 836-837
    CrossrefPubMedGoogle Scholar
  • 4 Estes C, Anstee QM, Arias-Loste MT. et al. Modeling NAFLD Disease Burden in China, France, Germany, Italy, Japan, Spain, United Kingdom, and United States for the period 2016-2030. J Hepatol 2018; 69: 896-904
    CrossrefPubMedGoogle Scholar
  • 5 Stefan N, Cusi K. A global view of the interplay between non-alcoholic fatty liver disease and diabetes. Lancet Diabetes Endocrinol. 2022 Feb 17: S2213-8587(22)00003-1. doi: 10.1016/S2213-8587(22)00003-1
    PubMed
  • 6 Zaharia OP, Strassburger K, Strom A. et al. Risk of diabetes-associated diseases in subgroups of patients with recent-onset diabetes: a 5-year follow-up study. Lancet Diabetes Endocrinol 2019; 7: 684-694
    CrossrefPubMedGoogle Scholar
  • 7 Tilg H, Moschen AR, Roden M. NAFLD and diabetes mellitus. Nat Rev Gastroenterol Hepatol 2017; 14: 32-42
    CrossrefPubMedGoogle Scholar
  • 8 European Association for the Study of the Liver (EASL); European European Association for the Study of the Liver (EASL); European Association for the Study of Diabetes (EASD); European Association for the Study of Obesity (EASO). EASL-EASD-EASO Clinical practice guidelines for the management of non-alcoholic fatty liver disease. Diabetologia 2016; 59: 1121-1140
    CrossrefPubMedGoogle Scholar
  • 9 Chalasani N, Younossi Z, Lavine JE. et al. The diagnosis and management of nonalcoholic fatty liver disease: Practice guidance from the American Association for the Study of Liver Diseases. Hepatology 2018; 67: 328-357
    CrossrefPubMedGoogle Scholar
  • 10 Bril F, McPhaul MJ, Caulfield MP. et al. Performance of the SteatoTest, ActiTest, NashTest and FibroTest in a multiethnic cohort of patients with type 2 diabetes mellitus. J Investig Med 2019; 67: 303-311
    CrossrefPubMedGoogle Scholar
  • 11 Singh S, Allen AM, Wang Z. et al. Fibrosis progression in nonalcoholic fatty liver vs nonalcoholic steatohepatitis: a systematic review and metaanalysis of paired-biopsy studies. Clin Gastroenterol Hepatol 2015; 13: 643-654.e1-9
    CrossrefPubMedGoogle Scholar
  • 12 Adams LA, Anstee QM, Tilg H. et al. Non-alcoholic fatty liver disease and its relationship with cardiovascular disease and other extrahepatic diseases. Gut 2017; 66: 1138-1153
    CrossrefPubMedGoogle Scholar
  • 13 Aminian A, Al-Kurd A, Wilson R et al. Association of Bariatric Surgery With Major Adverse Liver and Cardiovascular Outcomes in Patients With Biopsy-Proven Nonalcoholic Steatohepatitis. JAMA. 2021; 326, 2031–2042
    PubMed
  • 14 Newsome PN, Buchholtz K, Cusi K et al. A Placebo-Controlled Trial of Subcutaneous Semaglutide in Nonalcoholic Steatohepatitis. N Engl J Med. 2021; 384: 1113–1124
    PubMed