Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Department of Clinical Biochemistry, Royal Free Hospital Campus, University College London Medical School, University College London (UCL), London, United Kingdom.
Metabolism. 2019 Dec;101:154001. doi: 10.1016/j.metabol.2019.154001. Epub 2019 Oct 28.
Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in Western societies and a major cause of hepatic disease worldwide. Its more severe type, namely nonalcoholic steatohepatitis (NASH), may result in the development of cirrhosis and hepatocellular carcinoma. NAFLD, and especially NASH, are also associated with increased cardiovascular morbidity and mortality. Type 2 diabetes mellitus (T2DM) predisposes to NAFLD development and progression via insulin resistance and hyperglycemia. It has also been reported that the majority of T2DM patients have NAFLD/NASH, thus potentially further increasing their cardiometabolic risk. Current guidelines recommend to screen for NAFLD in all T2DM patients and vice-versa. Lifestyle remains the first-line therapeutic option for NAFLD/NASH. Among antidiabetic drugs, pioglitazone was shown to improve histological features of NASH. More recently, there is an increasing interest regarding the effects of newer anti-diabetic drugs, such as dipeptidyl peptidase 4 inhibitors (DPP-4i), sodium glucose cotransporter 2 inhibitors (SGLT2i), and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) on NAFLD/NASH. The present narrative review considers the up-to-date data on the impact of DPP-4i, SGLT2i, and GLP-1 RAs on biochemical and/or histological markers of NAFLD/NASH. The potential clinical implications of these findings in daily practice are also discussed. Taking into consideration the global increasing prevalence of NAFLD/NASH, therapeutic options that can prevent or treat this disease will exert considerable benefits on human health.
非酒精性脂肪性肝病 (NAFLD) 是西方社会最常见的慢性肝病，也是全球范围内肝脏疾病的主要原因。其更严重的类型，即非酒精性脂肪性肝炎 (NASH)，可能导致肝硬化和肝细胞癌的发展。NAFLD，尤其是 NASH，还与心血管发病率和死亡率的增加有关。2 型糖尿病 (T2DM) 通过胰岛素抵抗和高血糖促使 NAFLD 的发生和进展。也有报道称，大多数 T2DM 患者患有 NAFLD/NASH，从而可能进一步增加其心脏代谢风险。目前的指南建议对所有 T2DM 患者筛查 NAFLD，反之亦然。生活方式仍然是非酒精性脂肪性肝病/非酒精性脂肪性肝炎的一线治疗选择。在抗糖尿病药物中，吡格列酮被证明可以改善 NASH 的组织学特征。最近，人们对新型抗糖尿病药物（如二肽基肽酶 4 抑制剂 [DPP-4i]、钠-葡萄糖共转运蛋白 2 抑制剂 [SGLT2i] 和胰高血糖素样肽-1 受体激动剂 [GLP-1 RAs]）对 NAFLD/NASH 的影响越来越感兴趣。本叙述性评论考虑了 DPP-4i、SGLT2i 和 GLP-1 RAs 对 NAFLD/NASH 生化和/或组织学标志物影响的最新数据。还讨论了这些发现对日常实践的潜在临床意义。考虑到全球 NAFLD/NASH 的患病率不断增加，能够预防或治疗这种疾病的治疗选择将对人类健康产生巨大益处。
