Department of Medicine, Section of Endocrinology, Diabetes and Metabolism, University and Azienda Ospedaliera Universitaria Integrata of Verona, Piazzale Stefani 1, 37126 Verona, Italy.
Azienda Ospedaliera Universitaria di Modena, Ospedale Civile Sant'Agostino Estense, Via Giardini 1355, 41126 Baggiovara, Modena, Italy.
Nat Rev Endocrinol. 2018 Feb;14(2):99-114. doi: 10.1038/nrendo.2017.173. Epub 2017 Dec 29.
Nonalcoholic fatty liver disease (NAFLD) and diabetes mellitus are common diseases that often coexist and might act synergistically to increase the risk of hepatic and extra-hepatic clinical outcomes. NAFLD affects up to 70-80% of patients with type 2 diabetes mellitus and up to 30-40% of adults with type 1 diabetes mellitus. The coexistence of NAFLD and diabetes mellitus increases the risk of developing not only the more severe forms of NAFLD but also chronic vascular complications of diabetes mellitus. Indeed, substantial evidence links NAFLD with an increased risk of developing cardiovascular disease and other cardiac and arrhythmic complications in patients with type 1 diabetes mellitus or type 2 diabetes mellitus. NAFLD is also associated with an increased risk of developing microvascular diabetic complications, especially chronic kidney disease. This Review focuses on the strong association between NAFLD and the risk of chronic vascular complications in patients with type 1 diabetes mellitus or type 2 diabetes mellitus, thereby promoting an increased awareness of the extra-hepatic implications of this increasingly prevalent and burdensome liver disease. We also discuss the putative underlying mechanisms by which NAFLD contributes to vascular diseases, as well as the emerging role of changes in the gut microbiota (dysbiosis) in the pathogenesis of NAFLD and associated vascular diseases.
非酒精性脂肪性肝病（NAFLD）和糖尿病是常见的疾病，常并存且可能协同作用增加肝和肝外临床结局的风险。NAFLD 影响多达 70-80%的 2 型糖尿病患者和多达 30-40%的 1 型糖尿病患者。NAFLD 和糖尿病的共存不仅增加了更严重形式的 NAFLD 的发展风险，还增加了糖尿病慢性血管并发症的风险。事实上，大量证据表明，NAFLD 与 1 型或 2 型糖尿病患者发生心血管疾病和其他心脏及心律失常并发症的风险增加相关。NAFLD 还与发生微血管糖尿病并发症的风险增加相关，尤其是慢性肾脏病。本综述重点关注 NAFLD 与 1 型或 2 型糖尿病患者慢性血管并发症风险之间的强关联，从而提高对这种日益流行且负担沉重的肝病肝外影响的认识。我们还讨论了 NAFLD 导致血管疾病的潜在机制，以及肠道微生物组（生态失调）变化在 NAFLD 及相关血管疾病发病机制中的新兴作用。
