NAFLD: The associated risks and potential treatments
medwireNews: Researchers presented the results of several studies investigating the risks associated with nonalcoholic fatty liver disease (NAFLD) and potential treatment strategies at the EASD annual meeting in Lisbon, Portugal.
The prevalence of NAFLD is “increasing rapidly, and is part of the tsunami of diabetes and obesity,” said session chair Marja-Riitta Taskinen (University of Helsinki, Finland) in her introduction to the data presentations.
Two South Korean studies focused on the cardiovascular burden associated with fat in the liver. In the first, Minyoung Lee (Yonsei University College of Medicine, Seoul) and colleagues analyzed data from 454 patients with type 2 diabetes, and found that participants with NAFLD were significantly more likely to experience left-ventricular diastolic dysfunction than those without NAFLD, with an odds ratio (OR) of approximately 1.5 after adjustment for factors including age, body mass index, and diabetes duration.
And in the second study, Yu Mi Kang (Asan Medical Center, Seoul) and co-researchers investigated associations between fatty liver disease and coronary artery calcification (CAC) progression among 282 patients who were classified as having metabolically healthy obesity (MHO), and 316 with metabolically unhealthy obesity (MUO). They found that MUO individuals both with and without fatty liver disease had an increased risk for CAC compared with nonobese healthy controls (multivariate adjusted OR=2.03 and 2.32, respectively).
Among MHO individuals, however, only those with fatty liver disease had a significantly increased risk for CAC relative to the nonobese control group (OR=2.37).
Therefore, “fatty liver disease could serve as a risk determinant in the progression of subclinical atherosclerosis in MHO individuals,” said Kang.
And she concluded that “an obese population, especially those with fatty liver disease, cannot be considered as having a benign condition despite their healthy metabolic profile, and should be followed carefully.”
In another presentation on the adverse outcomes linked to fatty liver disease, Sarah Wild (University of Edinburgh, UK) described the results of a retrospective registry-based study of patients with type 2 diabetes in Scotland. The team found that the 1998 participants with NAFLD had a significantly higher risk for death from all causes, from cardiovascular disease, and from hepatocellular carcinoma than the 131,314 without NAFLD during an average 4.7 years of follow-up, with corresponding hazard ratios of 2.11, 1.39, and 41.9 after adjustment for factors including age, gender, smoking, and blood pressure.
“Our results provide further evidence that it is important to intervene early to prevent NAFLD progression,” said Wild.
“Since there are currently no licensed drugs for NAFLD, these data highlight the urgent need for effective treatments,” she concluded.
The final two presentations of the session demonstrated the potential of both drug and lifestyle treatments for the treatment of NAFLD in patients with type 2 diabetes.
In an observational study involving 247 patients who were treated with different classes of diabetes drugs, Anastasios Koutsovasilis (General Hospital of Nikaia-Piraeus, Athens, Greece) and colleagues showed that participants who were treated with the sodium–glucose cotransporter 2 inhibitor dapagliflozin experienced significant decreases in bodyweight and glycated hemoglobin (HbA1c) levels, and significant improvements in liver fibrosis as measured by the aspartate aminotransferase to platelet counts ratio (APRI) index after 52 weeks of treatment.
Patients who received treatment with pioglitazone also had significant improvements in HbA1c levels and APRI index scores, but no significant loss in bodyweight, over the study period, while those treated with the dipeptidyl peptidase-4 inhibitor sitagliptin only experienced significant improvements in HbA1c.
Although he cautioned that the study was limited by its small sample size and observational nature, Koutsovasilis concluded that treatment with dapagliflozin led “not only to good control of type 2 diabetes but also improvement of liver inflammation, alteration of liver fibrosis, and reduction of bodyweight,” which are “particularly important factors” in this patient group.
Finally, the results of a randomized trial compared the benefits of hypocaloric low-fat and low-carbohydrate diets, as reported here.
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