Non-alcoholic fatty liver disease (NAFLD) is prevalent in obese individuals, but may also affect non-obese insulin-resistant individuals.

Several studies have now shown that individuals with NAFLD/non-alcoholic steatohepatitis (NASH) are at a higher risk of developing type 2 diabetes (T2D)

It is well established that individuals with NASH are more insulin resistant, even if they are lean and without diabetes. 

NAFLD in T2D is a disease with unclear mechanisms and an individual genetic susceptibility that promotes the development and progression from fatty liver disease to NASH, cirrhosis and hepatocellular carcinoma. Not only the adjacent connotation with obesity, but also with IR and lipotoxicity, upsurges the risk of T2D and related comorbidities in NAFLD. Screening in the primary care setting, diabetes clinics and among hepatologists is more relevant than ever, as effective therapies are available, including lifestyle changes that induce weight loss, bariatric surgery, and medications currently available to treat diabetes and proven to be effective in NASH (i.e., pioglitazone, liraglutide). The American Diabetes Association in 2019 recommended universal screening for advanced fibrosis in all patients with prediabetes or T2D with steatosis or elevated ALT, in an effort to identify and treat those at the highest risk of developing advanced fibrosis. Of note, the target of screening and treatment is not steatosis per se, but NASH-induced liver fibrosis as it has been associated with increased morbidity and mortality. 

It is critically important to increase awareness among primary care physicians, specialists and health policy makers about the risks associated with this disease, since early diagnosis and treatment will be the only way to tackle the looming epidemic of NASH.

Source: JHEP Reports, 1(4): October 2019: 312-328