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Extrahepatic complications of liver fat
DOES STEATOSIS PLACE PATIENTS AT RISK FOR
DIABETES DEVELOPMENT AND PROGRESSION?
Naveed Sattar
Institute of Cardiovascular and Medical Sciences,
University of Glasgow, Glasgow, The United Kingdom
E-mail: naveed.sattar@glasgow.ac.uk
Take home messages
• NAFLD is a feature of ectopic fat accumulation and is strongly linked to insulin resistance and
T2DM risk factors.
• Excess liver fat is linked to both hepatic insulin resistance and increased hepatic triglyceride
production. It is believed by many that liver fat is part of the pathogenesis of T2DM in many patients.
• Patients who are considered to have NAFLD should have their glycemia status checked carefully.
• Alteration in weight trajectory, and ideally some weight loss, is a key facet of the management of
NAFLD.
• There is plentiful evidence that weight loss lessens risk of T2DM and improves liver fat levels in
parallel with improvements in hepatic insulin resistance.
NAFLD and T2DM
NAFLD is a feature of ectopic fat accumulation and is strongly linked to insulin resistance and T2DM
risk factors [1, 2]. Indeed, to diagnose NAFLD, the physician should look for a pattern whereby ALT is
greater than AST (with ALT more strongly linked to insulin resistance and obesity), raised triglycerides
and lower HDL-cholesterol, as well as obesity and potential abnormalities in glucose levels [1, 2]. All
of these features are risk factors for T2DM and it is therefore not surprising to note that NAFLD is
strongly linked to T2DM [1, 3]. Indeed, it is estimated that at least around half of all patients (more in
other studies) with T2DM have NAFLD [4], whereas NAFLD as estimated by ultrasound, or raised
ALT or GGT, appears to be an independent risk factor for development of T2DM [3].
Excess liver fat is linked to both hepatic insulin resistance and increased hepatic triglyceride production
(which in turns leads to lower HDL- cholesterol levels) and it is believed by many therefore that liver fat
is part of the pathogenesis of T2DM in many patients [5, 6]. There is also emerging evidence for excess
pancreatic fat as a feature of T2DM which appears to be associated with impaired beta cell function.
Interestingly, there is emerging evidence that weight loss can to some extent reverse these abnormalities
[5].
Diagnostic relevance of above patterns of association
Given strong associations of NAFLD with diabetes risk, it is clear that patients who are considered
to have NAFLD should have their glycemia status checked carefully [1]. This can be done using
either fasting blood glucose or HbA1c for patients not fasting. Doctors should however, avoid mixing
diagnostic criteria for diabetes. The finding of some derangement in glycemic status, whether it is frank
diabetes or a high risk state, adds evidence for the diagnosis of NAFLD and also can help support the
best management options for both the patient and the physician.
The International Liver Congress™ 2015 • Vienna, Austria • April 22–23, 2015 65
DOES STEATOSIS PLACE PATIENTS AT RISK FOR
DIABETES DEVELOPMENT AND PROGRESSION?
Naveed Sattar
Institute of Cardiovascular and Medical Sciences,
University of Glasgow, Glasgow, The United Kingdom
E-mail: naveed.sattar@glasgow.ac.uk
Take home messages
• NAFLD is a feature of ectopic fat accumulation and is strongly linked to insulin resistance and
T2DM risk factors.
• Excess liver fat is linked to both hepatic insulin resistance and increased hepatic triglyceride
production. It is believed by many that liver fat is part of the pathogenesis of T2DM in many patients.
• Patients who are considered to have NAFLD should have their glycemia status checked carefully.
• Alteration in weight trajectory, and ideally some weight loss, is a key facet of the management of
NAFLD.
• There is plentiful evidence that weight loss lessens risk of T2DM and improves liver fat levels in
parallel with improvements in hepatic insulin resistance.
NAFLD and T2DM
NAFLD is a feature of ectopic fat accumulation and is strongly linked to insulin resistance and T2DM
risk factors [1, 2]. Indeed, to diagnose NAFLD, the physician should look for a pattern whereby ALT is
greater than AST (with ALT more strongly linked to insulin resistance and obesity), raised triglycerides
and lower HDL-cholesterol, as well as obesity and potential abnormalities in glucose levels [1, 2]. All
of these features are risk factors for T2DM and it is therefore not surprising to note that NAFLD is
strongly linked to T2DM [1, 3]. Indeed, it is estimated that at least around half of all patients (more in
other studies) with T2DM have NAFLD [4], whereas NAFLD as estimated by ultrasound, or raised
ALT or GGT, appears to be an independent risk factor for development of T2DM [3].
Excess liver fat is linked to both hepatic insulin resistance and increased hepatic triglyceride production
(which in turns leads to lower HDL- cholesterol levels) and it is believed by many therefore that liver fat
is part of the pathogenesis of T2DM in many patients [5, 6]. There is also emerging evidence for excess
pancreatic fat as a feature of T2DM which appears to be associated with impaired beta cell function.
Interestingly, there is emerging evidence that weight loss can to some extent reverse these abnormalities
[5].
Diagnostic relevance of above patterns of association
Given strong associations of NAFLD with diabetes risk, it is clear that patients who are considered
to have NAFLD should have their glycemia status checked carefully [1]. This can be done using
either fasting blood glucose or HbA1c for patients not fasting. Doctors should however, avoid mixing
diagnostic criteria for diabetes. The finding of some derangement in glycemic status, whether it is frank
diabetes or a high risk state, adds evidence for the diagnosis of NAFLD and also can help support the
best management options for both the patient and the physician.
The International Liver Congress™ 2015 • Vienna, Austria • April 22–23, 2015 65
