NAFLD in type 1 diabetes: overrated or underappreciated?

• Published in: Therapeutic Advances in Endocrinology and Metabolism Vol. 12; p. 20420188211055557
• Main Authors: Mertens, Jonathan, Van Gaal, Luc F., Francque, Sven M., De Block, Christophe
• Format: Book Review Journal Article
• Language: English
• Published: London, England SAGE Publications 01-11-2021; Sage Publications Ltd; SAGE Publishing
• Subjects: Adipose tissue; Body weight; Cardiovascular diseases; Cirrhosis; Complications; Diabetes; Diabetes mellitus; Diabetes mellitus (insulin dependent); Diabetes mellitus (non-insulin dependent); Epidemiology; Fatty liver; Health risks; Heart diseases; Insulin; Insulin resistance; Kidney diseases; Liver; Liver cirrhosis; Liver diseases; Magnetic resonance imaging; Metabolic syndrome; Microvasculature; Morbidity; Mortality; Overweight; Review; metabolic syndrome; cardiovascular disease; NAFLD; type 1 diabetes; renal disease
• ISSN: 2042-0188; 2042-0196
• DOI: 10.1177/20420188211055557

Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in western countries, affecting 25–30% of the general population and up to 65% in those with obesity and/or type 2 diabetes. Accumulation of visceral adipose tissue and insulin resistance (IR) contributes to NAFLD. NAFLD is not an innocent entity as it not only may cause nonalcoholic steatohepatitis and cirrhosis but also contribute to cardiovascular morbidity and mortality. More and more people with type 1 diabetes (T1D) are becoming overweight and present with features of IR, but the prevalence and impact of NAFLD in this population are still unclear. The utility of noninvasive screening tools for NAFLD in T1D is being explored. Recent data indicate that based upon ultrasonographic criteria NAFLD is present in 27% (ranging between 19% and 31%) of adults with T1D. Magnetic resonance imaging data indicate a prevalence rate of 8.6% (ranging between 2.1% and 18.6%). There are, however, multiple factors affecting these data, ranging from study design and referral bias to discrepancies in between diagnostic modalities. Individuals with T1D have a 7-fold higher risk of cardiovascular disease (CVD) and cardiovascular mortality is the most prominent cause of death in T1D. Patients with T1D and NALFD are also more prone to develop CVD, but the independent contribution of NAFLD to cardiovascular events has to be determined in this population. Furthermore, limited data in T1D also point towards a 2 to 3 times higher risk for microvascular complications in those with NAFLD. In this article, we will discuss epidemiological and diagnostic challenges of NAFLD in T1D, explore the link between IR and NAFLD and chronic complications, and examine the independent contribution of NAFLD to the presence of macro-, and microvascular complications.