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World J Gastroenterol. 2014 Jul 21;20(27):9072-89. doi: 10.3748/wjg.v20.i27.9072.

Non-alcoholic fatty liver disease and type 2 diabetes mellitus: the liver disease of our age?

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Gábor Firneisz, 2 Department of Internal Medicine, Semmelweis University, H-1088 Budapest, Hungary.


Non-alcoholic fatty liver disease (NAFLD) is a chronic liver disease that might affect up to one-third of the adult population in industrialised countries. NAFLD incorporates histologically and clinically different non-alcoholic entities; fatty liver (NAFL, steatosis hepatis) and steatohepatitis (NASH-characterised by hepatocyte ballooning and lobular inflammation ± fibrosis) might progress to cirrhosis and rarely to hepatocellular cancer. NAFL increasingly affects children (paediatric prevalence is 4.2%-9.6%). Type 2 diabetes mellitus (T2DM), insulin resistance (IR), obesity, metabolic syndrome and NAFLD are particularly closely related. Increased hepatic lipid storage is an early abnormality in insulin resistant women with a history of gestational diabetes mellitus. The accumulation of triacylglycerols in hepatocytes is predominantly derived from the plasma nonesterified fatty acid pool supplied largely by the adipose tissue. A few NAFLD susceptibility gene variants are associated with progressive liver disease, IR, T2DM and a higher risk for hepatocellular carcinoma. Although not approved, pharmacological approaches might be considered in NASH patients.


Dysfunctional adipose tissue; Genetics; Hepatocellular cancer; Insulin resistance; Liver cirrhosis; Non-alcoholic fatty liver disease; Non-alcoholic steatohepatitis; Obesity; Therapy; Type 2 diabetes mellitus

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