Liver disorders in diabetic patients

Česká verzia

Authors: R. Brůha; K. Dvořák; J. Petrtýl
Authors place of work: IV. interní klinika 1. lékařské fakulty UK a VFN Praha, přednosta prof. MU Dr. Aleš Žák, DrSc.
Published in the journal: Vnitř Lék 2013; 59(7): 546-550
Category:

Summary

There is a mutual relationship between diabetes and liver disorders. Diabetic patients suffer from liver disorders more frequently and, vice versa, patients with liver disorders are at a higher risk of developing diabetes. Diabetes is probably the most common cause of chronic liver disorders in developed countries. Liver disorders related to diabetes include a wide spectrum of conditions, from a simple steatosis related to a slight elevation of liver tests through non‑alcoholic steatohepatitis with various degrees of fibrosis up to cirrhosis, hepatocellular carcinoma and acute liver failure. Non‑ alcoholic liver steatosis is the most common pathological condition that is, at present, considered to be a component of or to actually be the liver manifestation of metabolic syndrome, accompanied with an insulin resistance and other clinical components, such as central obesity, dyslipidemia, arterial hypertension and the already mentioned type 2 diabetes mellitus. The steatosis itself is a benign condition and the unfavourable development of the liver disorder is related to an inflammatory reaction (steatohepatitis) and subsequent fibrosis. There is no specific treatment for non‑alcoholic steatohepatitis. The basic measures include weight reduction, lifestyle changes and treatment of the concurrent conditions, such as diabetes and dyslipidemia. Formerly popular „hepatoprotective“ substances do not play an important role in the treatment of steatohepatitis.

Key words:
type 2 diabetes mellitus – liver steatosis – NAFLD – NASH – cirrhosis

Zdroje

1. Seppälä‑ Lindroos A, Vehkavaara S, Häkkinen AM et al. Fat accumulation in the liver is associated with defects in insulin suppression of glucose production and serum free fatty acids independent of obesity in normal men. J Clin Endocrinol Metab 2002; 87: 3023– 3028.

2. Rashid S, Watanabe T, Sakaue T et al. Mechanism of HDL lowering in insulin resistant, hypertriglyceridemic states: the combined effect of HDL triglyceride enrichment and elevated hepatic lipase activity. Clin Biochem 2003; 36: 421– 429.

3. Czaja MJ. JNK regulation of hepatic manifestations of the metabolic syndrome. Trends Endocrinol Metab 2010; 21: 707– 713.

4. El‑ Serag HB, Tran T, Everhart JE. Diabetes increases the risk of chronic liver disease and hepatocellular carcinoma. Gastroenterology 2004; 126: 460– 468.

5. de Marco R, Locatelli F, Zoppini G et al. Cause‑ specific mortality in type 2 diabetes. The Verona Diabetes Study. Diabetes Care 1999; 22: 756– 761.

6. Brodanová M. Diabetes mellitus a játra. Vnitř Lék 2001; 47: 238– 244.

7. Brůha R. Nealkoholová steatóza a steatohepatitída – editorial. Vnitř Lék 2010; 56: 173– 175.

8. Marchesini G, Bugianesi E, Forlani G et al. Nonalcoholic fatty liver, steatohepatitis, and the metabolic syndrome. Hepatology 2003; 37: 917– 923.

9. Chitturi S, Abeygunasekera S, Farrell GC et al.NASH and insulin resistance: Insulin hypersecretion and specific association with the insulin resistance syndrome. Hepatology 2002; 35: 373– 379.

10. Ludwig J, Viggiano RT, McGill DB et al. Nonalcoholic steatohepatitis: Mayo Clinic experience with a hitherto unnamed disease. Mayo Clin Proc 1980; 55: 434– 438.

11. Angulo P. Nonalcoholic fatty liver disease. N Engl J Med 2002; 346: 1221– 1231.

12. Ehrmann J, Hůlek P et al. Hepatologie. Praha: Grada Publishing 2010.

13. Wieckowska A, McCullough AJ, Feldstein AE.Noninvasive diagnosis and monitoring of nonalcoholic steatohepatitis: present and future. Hepatology 2007; 46: 582– 589.

14. Sandrin L, Fourquet B, Hasquenoph JM et al. Transient elastography: a new noninvasive method for assessment of hepatic fibrosis. Ultrasound Med Biol 2003; 29: 1705– 1713.

15. Rifai K, Cornberg J, Mederacke I et al. Clinical feasibility of liver elastography by acoustic radiation force impulse imaging (ARFI). Dig Liver Dis 2011; 43: 491– 497.

16. Adams LA, Lymp JF, St Sauver J et al. The natural history of nonalcoholic fatty liver disease: a population‑based cohort study. Gastroenterology 2005; 129: 113– 121.

17. Caldwell S, Argo C. The natural history of non‑alcoholic fatty liver disease. Dig Dis 2010; 28: 162– 168.

18. Matteoni CA, Younossi ZM, Gramlich T et al.Nonalcoholic fatty liver disease: a spectrum of clinical and pathological severity. Gastroenterology 1999; 116: 1413– 1419.

19. Hultcrantz R, Glaumann H, Lindberg G et al. Liver investigation in 149 asymptomatic patients with moderately elevated activities of serum aminotransferases. Scand J Gastroenterol 1986; 21: 109– 113.

20. Cortez‑ Pinto H, Baptista A, Camilo E et al. Nonalcoholic steatohepatitis clinicopathological comparison with alcoholic hepatitis in ambulatory and hospitalized patients. Dig Dis Sci 1996; 41: 172– 179.

21. Bellentani S, Saccoccio G, Costa G et al. Drinking habits as cofactors of risk for alcohol induced liver damage. The Dionysos Study Group. Gut 1997; 41: 845– 850.

22. Snow WM, Murray R, Ekuma O et al. Alcohol use and cardiovascular health outcomes: a comparison across age and gender in the Winnipeg Health and Drinking Survey Cohort. Age Ageing 2009; 38: 206– 212.

23. Bellentani S, Dalle Grave R, Suppini A et al. Behavior therapy for nonalcoholic fatty liver disease: the need for a multidisciplinary approach. Hepatology 2008; 47: 746– 754.

24. Ueno T, Sugawara H, Sujaku K et al. Therapeutic effects of restricted diet and exercise in obese patients with fatty liver. J Hepatol 1997; 27: 103– 107.

25. Musso G, Bambino R, Cassader M et al. A meta‑analysis of randomized trials for the treatment of nonalcoholic fatty liver disease. Hepatology 2010; 52: 79– 104.

26. Mahady SE, Webster AC, Walker S et al. The role of thiazolidinediones in non‑alcoholic steatohepatitis – a systematic review and meta analysis. J Hepatol 2011; 55: 1383– 1390.

27. Sanyal AJ, Chalasani N, Kowdley KV et al. Pioglitazone, vitamin E, or placebo for nonalcoholic steatohepatitis. N Engl J Med 2010; 362: 1675– 1685.

28. Li W, Zheng L, Sheng C et al. Systematic review on the treatment of pentoxifylline in patients with non‑alcoholic fatty liver disease. Lipids Health Dis 2011; 10: 49.

29. Hickman IJ, Macdonald GA. Impact of diabetes on the severity of liver disease. Am J Med 2007; 120: 829– 834.

30. Tolman KG, Fonseca V, Dalpiaz A et al. Spectrum of liver disease in type 2 diabetes and management of patients with diabetes and liver disease. Diabetes Care 2007; 30: 734– 743.

31. Caldwell SH, Oelsner DH, Iezzoni JC et al. Cryptogenic cirrhosis: clinical characterization and risk factors for underlying disease. Hepatology 1999; 29: 664– 669.

32. Wideroff L, Gridley G, Mellemkjaer L et al. Cancer incidence in a population‑based cohort of patients hospitalized with diabetes mellitus in Denmark. J Natl Cancer Inst 1997; 89: 1360– 1365.

33. Nair S, Mason A, Eason J et al. Is obesity an independent risk factor for hepatocellular carcinoma in cirrhosis? Hepatology 2002; 36: 150– 155.

34. El‑ Serag HB, Everhart JE. Diabetes increases the risk of acute hepatic failure. Gastroenterology 2002; 122: 1822– 1828.

35. Chan KA, Truman A, Gurwitz JH et al. A cohort study of the incidence of serious acute liver injury in diabetic patients treated with hypoglycemic agents. Arch Intern Med 2003; 163: 728– 734.

36. White DL, Ratziu V, El‑ Serag HB. Hepatitis C infection and risk of diabetes: a systematic review and meta‑analysis. J Hepatol 2008; 49: 831– 844.

37. Miyamoto H, Moriishi K, Moriya K et al. Involvement of the PA28gamma‑ dependent pathway in insulin resistance induced by hepatitis C virus core protein. J Virol 2007; 81: 1727– 1735.

38. Romero‑Gomez M, Del Mar Viloria M, An-drade RJ et al. Insulin resistance impairs sustained response rate to peginterferon plus ribavirin in chronic hepatitis C patients. Gastroenterology 2005; 128: 636– 641.

39. Fabris P, Floreani A, Tositti G et al. Type 1 diabetes mellitus in patients with chronic hepatitis C before and after interferon therapy. Aliment Pharmacol Ther 2003; 18: 549– 558.