By: Daniel Trecroci
Nonalcoholic fatty liver disease (NAFLD) is significantly associated with a moderately increased cardiovascular disease risk among type 2s, according to Italian researchers.
The researchers carried out a study in 2,103 type 2s who were free of diagnosed cardiovascular disease (CVD) at the beginning of the study. During five years of follow-up, 248 participants developed nonfatal coronary heart disease, ischemic stroke or cardiovascular death.
“After adjustment for age, sex, smoking history, diabetes duration, HbA1c, LDL cholesterol, liver enzymes and use of medications, the presence of NAFLD was significantly associated with an increased CVD risk.”
—Diabetes, December 2005
Giovanni Targher, MD, of the Division of Internal Medicine and Diabetes Unity at Sacro Cuore Hospital of Negrar in Verona, Italy, was a lead researcher on the fatty liver study:
What are the symptoms of NAFLD?
Most patients with NAFLD have no symptoms or clinical signs of liver disease at the time of diagnosis, although some patients report fatigue or malaise and a sensation of fullness or discomfort on the right side of the upper abdomen. Hepatomegaly may be the only physical finding in most patients.
Are there any tests that type 2 diabetics can have to detect NAFLD?
The diagnosis of NAFLD in clinical practice, both among nondiabetic subjects and type 2 diabetic patients, can usually be made through medical history, blood testing and imaging studies:
- Medical history: Exclusion of alcohol abuse and exclusion of other known causes of chronic liver disease (viral hepatitis, autoimmune hepatitis or use of hepato-toxic drugs).
- Blood testing: The presence of mildly to moderately elevated serum levels of aminotransferases (liver enzymes) are the most common and often the only laboratory abnormality found in NAFLD patients; other laboratory abnormalities may be found in patients with more advanced forms of NAFLD (cirrhosis).
- Imaging studies: Ultrasonography is the most widely used imaging test for diagnosing NAFLD. On ultrasonography, fatty infiltration of the liver produces a typical diffuse increase in echogenicity (so-called bright liver). However, ultrasound, although of help in determining the presence and the amount of fatty liver infiltration, cannot be used to accurately determine the severity of liver damage. The clinical suspicion of NAFLD and its severity (that is, simple steatosis, steatohepatitis, advanced fibrosis or cirrhosis) can be confirmed only with a liver biopsy (used sparingly in clinical practice).
What are some treatment options for people who have NAFLD?
An attempt at gradual weight reduction with appropriate control of plasma glucose and lipid levels (particularly in diabetic patients) is a useful first step. Pharmacologic therapy aimed at the underlying liver disease holds promise. Currently, there are only small pilot studies using insulin-sensitizing oral agents (metformin and glitazones) that have been shown to improve liver function tests as well as histologic findings.