NASH and diabetes
Last edited 06/2020 and last reviewed 09/2021Non-alcoholic fatty liver disease (NAFLD) includes a wide spectrum of liver pathology, ranging from fatty liver alone to the more severe nonalcoholic steatohepatitis (1)
is the most common cause of chronically elevated LFTs in the United States in
both diabetic and nondiabetic individuals
- with respect to patients with NAFLD, 60-95% are obese, 28-55% have type 2 diabetes, and 20-92% have hyperlipidemia (2)
- if NAFLD develops in people who are not heavy
drinkers then the condition generally has a benign clinical course (3,4)
- NAFLD is a cause of hepatic inflammation histologically resembling that of alcohol-induced liver disease but usually slowly progressive and of low-grade severity. ..However, the disorder may ultimately result in cirrhosis (4)
- there is evidence of associations between NAFLD and obesity, dyslipidaemia and insulin resistance (4,5)
- NAFLD generally results in an asymptomatic elevation of liver enzyme levels (6), including ALT and AST - ALT is primarily found in the liver whereas AST is also found in other tissues and is a less specific marker of liver integrity
- in the setting of marker-negative elevated LFTs, the most likely histological diagnosis is fatty metamorphosis of the liver with occasional associated fibrosis (6)
- significant iron accumulation is not seen in NAFLD (7)
A suggested schemata regarding the assessment of NAFLD in type 2 diabetes has been outlined (8):
- Angulo P. Nonalcoholic fatty liver disease. N Engl J Med 2002;346: 1221-31.
- Harris EH.Elevated Liver Function Tests in Type 2 Diabetes.Clinical Diabetes 2005; 23:115-119.
- Matteoni CA, Younossi ZM, Gramlich T, Boparai N, Liu YC, McCullough AJ. Nonalcoholic fatty liver disease: a spectrum of clinical and pathological severity. Gastroenterology 1999;116: 1413-9.
- Powell EE, Cooksley WG, Hanson R, Searle J, Halliday JW, Powell LW. The natural history of nonalcoholic steatohepatitis. a follow-up study of forty-two patients for up to 21 years. Hepatology 1990;11: 74-80.
- Marchesini G, Bugianesi E, Forlani G, Cerrelli F, Lenzi M, Manini R, Bop M et al. Nonalcoholic fatty liver, steatohepatitis, and the metabolic syndrome. Hepatology 2003;37: 917-23.
- Daniel S, Ben Menachem T, Vasudevan G, Ma CK, Blumenkehl M. Prospective evaluation of unexplained chronic liver transaminase abnormalities in asymptomatic and symptomatic patients. Am J Gastroenterol 1999;94: 3010-4.
- Hepatology. 1999 Oct;30(4):847-50.
- The North West London Health and Care Partnership. North West London Diabetes Guidelines (Accessed 16/6/2020).