Division of Endocrinology and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata, Piazzale Stefani, 1, 37126 Verona, Italy.
J Clin Endocrinol Metab. 2013 Feb;98(2):483-95. doi: 10.1210/jc.2012-3093. Epub 2013 Jan 4.
Nonalcoholic fatty liver disease (NAFLD) is increasingly diagnosed worldwide and is the most common chronic liver disease in Western countries. In this review, we discuss the role of NAFLD as a novel cardiometabolic risk factor for the development of type 2 diabetes (T2DM) and for the development of major chronic complications and poor glycemic control in people with established T2DM.
This is a clinical, narrative review and not a systematic review and meta-analysis. PubMed was extensively searched for articles using the keywords "nonalcoholic fatty liver disease" or "fatty liver" combined with "diabetes risk," "cardiovascular risk," "cardiovascular mortality," "chronic kidney disease," or "diabetic nephropathy" between 1990 and 2012. Articles published in languages other than English were excluded from the analysis.
NAFLD exacerbates hepatic insulin resistance and increases the risk of developing T2DM. Growing evidence also indicates that NAFLD may worsen glycemic control in people with T2DM and may contribute to the development and progression of the most important chronic complications of diabetes, such as cardiovascular disease and chronic kidney disease.
The adverse impact of NAFLD on risk for T2DM and its major chronic vascular complications deserves particular attention among endocrinologists/cardiologists/hepatologists, in view of the implications for screening and surveillance strategies in the growing number of patients with NAFLD. Clinicians who manage patients with NAFLD should not only focus on liver disease, but should also recognize the increased risk of developing T2DM and its chronic vascular complications and undertake early, aggressive risk factor modification.
非酒精性脂肪性肝病（NAFLD）在全球范围内的诊断率日益增高，是西方国家最常见的慢性肝病。在这篇综述中，我们讨论了 NAFLD 作为一种新型的代谢相关心血管风险因子在 2 型糖尿病（T2DM）发病风险、以及在已确诊的 T2DM 患者中主要慢性并发症和血糖控制不良方面的作用。
这是一篇临床综述，而非系统综述和荟萃分析。我们在 PubMed 数据库中使用“非酒精性脂肪性肝病”或“脂肪肝”作为关键词，联合“糖尿病风险”、“心血管风险”、“心血管死亡率”、“慢性肾病”或“糖尿病肾病”进行了广泛的检索，检索时间范围为 1990 年至 2012 年。分析排除了非英文文献。
NAFLD 可加重肝脏胰岛素抵抗并增加发生 T2DM 的风险。越来越多的证据还表明，NAFLD 可能会使 T2DM 患者的血糖控制恶化，并可能导致糖尿病最重要的慢性并发症（如心血管疾病和慢性肾病）的发生和进展。
鉴于非酒精性脂肪性肝病患者数量不断增加，对其筛查和监测策略的影响，内分泌学家/心脏病学家/肝病学家应特别关注 NAFLD 对 T2DM 发病风险及其主要慢性血管并发症的不利影响。管理 NAFLD 患者的临床医生不仅应关注肝脏疾病，还应认识到发生 T2DM 及其慢性血管并发症的风险增加，并尽早采取积极的危险因素干预措施。
