Division of Endocrinology & Metabolism, University Hospital Southampton and University of Southampton, Southampton, UK.
Diabet Med. 2022 Oct;39(10):e14912. doi: 10.1111/dme.14912. Epub 2022 Jul 20.
Nonalcoholic fatty liver disease (NAFLD) was first described in the 1980s, but in the 21st century, NAFLD has become a very common condition. The explanation for this relatively recent problem is in large part due to the recent epidemic of obesity and type 2 diabetes (T2DM) increasing the risk of NAFLD. NAFLD is a silent condition that may not become manifest until severe liver damage (fibrosis or cirrhosis) has occurred. Consequently, NAFLD and its complications often remain undiagnosed. Research evidence shows that NAFLD is extremely common and some estimates suggest that it occurs in up to 70% of people with T2DM. In the last 5 years, it has become evident that NAFLD not only increases the risk of cirrhosis, primary liver cancer and end-stage liver disease, but NAFLD is also an important multisystem disease that has major implications beyond the liver. NAFLD increases the risk of incident T2DM, cardiovascular disease, chronic kidney disease and certain extra-hepatic cancers, and NAFLD and T2DM form part of a vicious spiral of worsening diseases, where one condition affects the other and vice versa. Diabetes markedly increases the risk of liver fibrosis and liver fibrosis is the most important risk factor for hepatocellular carcinoma. It is now possible to diagnose liver fibrosis with non-invasive tools and therefore it is important to have clear care pathways for the management of NAFLD in patients with T2DM. This review summarises key recent research that was discussed as part of the Banting lecture at the annual scientific conference in 2022.
非酒精性脂肪性肝病（NAFLD）于 20 世纪 80 年代首次被描述，但在 21 世纪，NAFLD 已成为一种非常常见的疾病。这种相对较新的问题的解释在很大程度上归因于肥胖和 2 型糖尿病（T2DM）的流行，这增加了 NAFLD 的风险。NAFLD 是一种无声的疾病，直到发生严重的肝损伤（纤维化或肝硬化）时才会显现出来。因此，NAFLD 及其并发症通常未被诊断。研究证据表明，NAFLD 非常普遍，一些估计表明，高达 70%的 T2DM 患者患有该病。在过去的 5 年中，已经明显的是，NAFLD 不仅会增加肝硬化、原发性肝癌和终末期肝病的风险，而且还是一种重要的多系统疾病，其对肝脏以外的影响也非常重要。NAFLD 会增加 2 型糖尿病、心血管疾病、慢性肾病和某些肝外癌症的发病风险，NAFLD 和 T2DM 形成了疾病恶化的恶性循环的一部分，一种疾病会影响另一种疾病，反之亦然。糖尿病会显著增加肝纤维化的风险，而肝纤维化是肝细胞癌的最重要危险因素。现在可以使用非侵入性工具来诊断肝纤维化，因此，对于 T2DM 患者的 NAFLD 管理，制定明确的护理途径非常重要。本综述总结了 2022 年年度科学会议上作为班廷讲座的一部分讨论的最近的一些关键研究。
