Prevalence of nonalcoholic fatty liver disease in patients with type 2 diabetes mellitus: A meta-analysis.
TL;DR: The high pooled prevalence of NAFLD in T2DM patients found in this study significantly underscores the need for early assessment ofNAFLD and the importance of strengthening the management of NA FLD inT2 DM patients.
About: This article is published in Medicine.The article was published on 2017-09-01 and is currently open access. It has received 193 citations till now. The article focuses on the topics: Nonalcoholic fatty liver disease & Type 2 Diabetes Mellitus.
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TL;DR: Evidence is provided supporting high prevalence of NAFLD and NASH in patients with T2DM around the world and regional and global mean prevalence weighted by population size in each country were estimated and pooled using random-effects meta-analysis.
1,032 citations
University of Sydney1, The Chinese University of Hong Kong2, Shanghai Jiao Tong University3, Kurume University4, Yonsei University5, Wenzhou Medical College6, Mansoura University7, Marmara University8, University of Indonesia9, Bangabandhu Sheikh Mujib Medical University10, National University of Singapore11, National Taiwan University12, Aga Khan University13, University of Malaya14, Mahidol University15, University of Western Australia16, University of Tokyo17
TL;DR: The clinical practice guidelines of the Asian Pacific Association for the Study of the Liver on MAFLD are presented to improve patient care and awareness of the disease and assist stakeholders in the decision-making process by providing evidence-based data.
Abstract: Metabolic associated fatty liver disease (MAFLD) is the principal worldwide cause of liver disease and affects nearly a quarter of the global population. The objective of this work was to present the clinical practice guidelines of the Asian Pacific Association for the Study of the Liver (APASL) on MAFLD. The guidelines cover various aspects of MAFLD including its epidemiology, diagnosis, screening, assessment, and treatment. The document is intended for practical use and for setting the stage for advancing clinical practice, knowledge, and research of MAFLD in adults, with specific reference to special groups as necessary. The guidelines also seek to improve patient care and awareness of the disease and assist stakeholders in the decision-making process by providing evidence-based data. The guidelines take into consideration the burden of clinical management for the healthcare sector.
361 citations
Cites background from "Prevalence of nonalcoholic fatty li..."
...5% and up to 10–20% have advanced fibrosis [68]....
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TL;DR: The proper understanding of NAFLD spectrum—as a continuum from obesity to metabolic syndrome and diabetes—may contribute to the early identification and for establishment of targeted treatment.
Abstract: The prevalence of non-alcoholic fatty liver disease (NAFLD) has been increasing rapidly. It is nowadays recognized as the most frequent liver disease, affecting a quarter of global population and regularly coexisting with metabolic disorders such as type 2 diabetes, hypertension, obesity, and cardiovascular disease. In a more simplistic view, NAFLD could be defined as an increase in liver fat content, in the absence of secondary cause of steatosis. In fact, the clinical onset of the disease is a much more complex process, closely related to insulin resistance, limited expandability and dysfunctionality of adipose tissue. A fatty liver is a main driver for a new recognized liver-pancreatic α-cell axis and increased glucagon, contributing to diabetes pathophysiology. This review will focus on the clinical and pathophysiological connections between NAFLD, insulin resistance and type 2 diabetes. We reviewed non-invasive methods and several scoring systems for estimative of steatosis and fibrosis, proposing a multistep process for NAFLD evaluation. We will also discuss treatment options with a more comprehensive view, focusing on the current available therapies for obesity and/or type 2 diabetes that impact each stage of NAFLD. The proper understanding of NAFLD spectrum—as a continuum from obesity to metabolic syndrome and diabetes—may contribute to the early identification and for establishment of targeted treatment.
236 citations
TL;DR: The European Association for the Study of the Liver (EASL) proposed a framework for the principal actions required to improve liver health in Europe as mentioned in this paper , which can serve as a powerful mechanism for improving liver care in Europe.
151 citations
TL;DR: This Review describes the pathophysiological roles of peroxisome proliferator-activated receptors (PPARs) in nonalcoholic steatohepatitis and related metabolic diseases, and summarizes the preclinical and clinical data on the use of PPAR agonists to treat nonalcoholIC steato hepatitis as part of a systemic metabolic disease.
Abstract: The increasing epidemic of obesity worldwide is linked to serious health effects, including increased prevalence of type 2 diabetes mellitus, cardiovascular disease and nonalcoholic fatty liver disease (NAFLD). NAFLD is the liver manifestation of the metabolic syndrome and includes the spectrum of liver steatosis (known as nonalcoholic fatty liver) and steatohepatitis (known as nonalcoholic steatohepatitis), which can evolve into progressive liver fibrosis and eventually cause cirrhosis. Although NAFLD is becoming the number one cause of chronic liver diseases, it is part of a systemic disease that affects many other parts of the body, including adipose tissue, pancreatic β-cells and the cardiovascular system. The pathomechanism of NAFLD is multifactorial across a spectrum of metabolic derangements and changes in the host microbiome that trigger low-grade inflammation in the liver and other organs. Peroxisome proliferator-activated receptors (PPARs) are a group of nuclear regulatory factors that provide fine tuning for key elements of glucose and fat metabolism and regulate inflammatory cell activation and fibrotic processes. This Review summarizes and discusses the current literature on NAFLD as the liver manifestation of the systemic metabolic syndrome and focuses on the role of PPARs in the pathomechanisms as well as in the potential targeting of disease.
142 citations
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TL;DR: In this paper, an adjusted rank correlation test is proposed as a technique for identifying publication bias in a meta-analysis, and its operating characteristics are evaluated via simulations, and the test statistic is a direct statistical analogue of the popular funnel-graph.
Abstract: An adjusted rank correlation test is proposed as a technique for identifying publication bias in a meta-analysis, and its operating characteristics are evaluated via simulations. The test statistic is a direct statistical analogue of the popular "funnel-graph." The number of component studies in the meta-analysis, the nature of the selection mechanism, the range of variances of the effect size estimates, and the true underlying effect size are all observed to be influential in determining the power of the test. The test is fairly powerful for large meta-analyses with 75 component studies, but has only moderate power for meta-analyses with 25 component studies. However, in many of the configurations in which there is low power, there is also relatively little bias in the summary effect size estimate. Nonetheless, the test must be interpreted with caution in small meta-analyses. In particular, bias cannot be ruled out if the test is not significant. The proposed technique has potential utility as an exploratory tool for meta-analysts, as a formal procedure to complement the funnel-graph.
13,373 citations
TL;DR: As the global epidemic of obesity fuels metabolic conditions, the clinical and economic burden of NAFLD will become enormous, and random‐effects models were used to provide point estimates of prevalence, incidence, mortality and incidence rate ratios.
6,746 citations
Additional excerpts
...65%) among general population.([1]) NAFLD...
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TL;DR: This is a practice guideline for clinicians rather than a review article and interested readers can refer to several comprehensive reviews published recently.
3,212 citations
TL;DR: Mortality among community-diagnosed NAFLD patients is higher than the general population and is associated with older age, impaired fasting glucose, and cirrhosis, although the absolute risk is low.
2,681 citations
"Prevalence of nonalcoholic fatty li..." refers background in this paper
...1 includes a spectrum of diseases ranging from simple steatosis to nonalcoholic steatohepatitis (NASH), and to advanced fibrosis and cirrhosis and hepatocellular carcinoma, causing considerable liver-related morbidity and mortality.([2]) Accumulated evidence has indicated that NAFLD could be regarded as part of or, indeed, a hepatic manifestation of metabolic syndrome associated...
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TL;DR: It is concluded that NAFLD, in the presence of normoglycemia and normal or moderately increased body weight, is characterized by clinical and laboratory data similar to those found in diabetes and obesity.
Abstract: Insulin sensitivity (euglycemic clamp, insulin infusion rate: 40 mU m(-2) min(-1)) was studied in 30 subjects with biopsy-proven nonalcoholic fatty liver disease (NAFLD), normal glucose tolerance, and a BMI <30 kg/m(2) Of those 30 subjects, 9 had pure fatty liver and 21 had evidence of steatohepatitis In addition, 10 patients with type 2 diabetes under good metabolic control and 10 healthy subjects were studied Most NAFLD patients had central fat accumulation, increased triglycerides and uric acid, and low HDL cholesterol, irrespective of BMI Glucose disposal during the clamp was reduced by nearly 50% in NAFLD patients, as well as in patients with normal body weight, to an extent similar to that of the type 2 diabetic patients Basal free fatty acids were increased, whereas insulin-mediated suppression of lipolysis was less effective (-69% in NAFLD vs -84% in control subjects; P = 0003) Postabsorptive hepatic glucose production (HGP), measured by [6,6-(2)H(2)]glucose, was normal In response to insulin infusion, HGP decreased by only 63% of basal in NAFLD vs 84% in control subjects (P = 0002) Compared with type 2 diabetic patients, NAFLD patients were characterized by lower basal HGP, but with similarly reduced insulin-mediated suppression of HGP There was laboratory evidence of iron overload in many NAFLD patients, but clinical, histological, and biochemical data (including insulin sensitivity) were not correlated with iron status Four subjects were heterozygous for mutation His63Asp of the HFE gene of familiar hemochromatosis We concluded that NAFLD, in the presence of normoglycemia and normal or moderately increased body weight, is characterized by clinical and laboratory data similar to those found in diabetes and obesity NAFLD may be considered an additional feature of the metabolic syndrome, with specific hepatic insulin resistance
2,367 citations
"Prevalence of nonalcoholic fatty li..." refers background in this paper
...5 these findings, it is deduced that NAFLD may be a hepatic manifestation of metabolic syndrome.([3,4]) Consistently, this study found that the prevalence of NAFLD in T2DM patients differed significantly with differences in sample characteristics, including obesity, hypertension, and dyslipidemia....
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...with metabolic risk factors such as obesity, diabetes mellitus, and dyslipidemia.([3,4]) The association between NAFLD and type 2 diabetes mellitus (T2DM) has been well established, which could be explained by the insulin-resistance and compensatory hyperinsulinemia progressing to defective lipid metabolism and hepatic triglyceride (TG) accumulation in NAFLD or to b-cell dysfunction in T2DM....
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