Diabetes and the Liver
Non-alcoholic fatty liver disease (NAFLD) is the most common form of chronic liver disease in the western world. The syndrome encompasses a spectrum of histopathological changes in the liver ranging from benign fatty infiltration (steatosis) to steatosis with inflammation with or without necrosis (steatohepatitis) to cirrhosis. NAFLD is strongly associated with type 2 diabetes. The complex interaction of insulin resistance, inflammatory cytokines and fibrogenic factors lead to development and progression of NALFD. There is no one diagnostic test for NAFLD. Fatty liver disease is usually diagnosed during evaluation for elevation in liver tests or in the setting of radiological evidence of excess fat deposition in the liver. Liver biopsy is the current gold standard for the diagnosis of fatty liver disease. It also provides an assessment of the extent and severity of hepatocellular injury and fibrosis. There is no established treatment for NAFLD. Targeted therapy antagonizes the mechanisms central to the development of obesity, insulin resistance, intrahepatic oxidative stress and inflammation. The diversity of available treatment modalities (lifestyle modification, medication, surgical intervention) reflects the complex pathogenesis of the disease. © 2012 John Wiley & Sons, Ltd..
