scholarly journals Extrahepatic Diseases and NAFLD: The Triangular Relationship between NAFLD, Type 2-Diabetes and Dysbiosis

2016 ◽  
Vol 34 (Suppl. 1) ◽  
pp. 11-18 ◽  
Author(s):  
Eleonora Scorletti ◽  
Christopher D. Byrne
Keyword(s):  
Hepatocellular Carcinoma ◽  
Insulin Resistance ◽  
Type 2 Diabetes ◽  
Risk Factor ◽  
Liver Disease ◽  
Hepatitis C ◽  
End Stage Liver Disease ◽  
Triangular Relationship ◽  
End Stage

Non-alcoholic fatty liver disease (NAFLD) encompasses a spectrum of liver diseases from simple steatosis with hepatic lipid accumulation to end-stage liver disease with decompensated cirrhosis, liver failure and hepatocellular carcinoma. Recent data from the USA showed that in 2013, NAFLD was the second most frequent indication for liver transplantation behind hepatitis C. Since there are now effective treatments for hepatitis C and there is currently no licensed treatment for NAFLD, it has been predicted that over the next 10-15 years, NAFLD will replace hepatitis C as the most frequent indication for liver transplantation. Besides, increasing the risk of hepatocellular carcinoma and end-stage liver disease, it has recently become clear that NAFLD also increases risk of extrahepatic diseases such as type 2 diabetes mellitus (T2DM), cardiovascular disease, cardiac diseases and chronic kidney disease, to name but a few. Of each of these extrahepatic diseases, the evidence to date suggests that NAFLD is a strong risk factor for T2DM. When NAFLD occurs in combination with obesity and insulin resistance (as it frequently does), there is a marked increase in risk of incident T2DM with possible synergism occurring between liver fat accumulation, insulin resistance and obesity to further increase risk of development of T2DM. Thus, there is a reciprocal relationship between NAFLD as a risk factor for T2DM, and T2DM as a risk factor for liver disease progression in NAFLD. Moreover, recent evidence now points to the importance of perturbation of the intestinal microbiota (dysbiosis) in both T2DM and NAFLD. Consequently, there is a triangular relationship between dysbiosis and T2DM and NAFLD. This review will focus on T2DM as a key extrahepatic complication of NAFLD and will describe and discuss the triangular relationship between dysbiosis and T2DM and NAFLD and the factors and potential mechanisms underpinning this relationship.

scholarly journals Data linkage to monitor hepatitis C‐associated end‐stage liver disease and hepatocellular carcinoma inpatient stays in England

2019 ◽  
Vol 27 (1) ◽  
pp. 20-27
Author(s):  
Georgina Ireland ◽  
Ruth Simmons ◽  
Matthew Hickman ◽  
Ross Harris ◽  
Mary Ramsay ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Disease ◽  
Hepatitis C ◽  
Data Linkage ◽  
End Stage Liver Disease ◽  
End Stage

scholarly journals Association of liver cirrhosis severity with type 2 diabetes mellitus in hepatocellular carcinoma

2017 ◽  
Vol 243 (4) ◽  
pp. 323-326
Author(s):  
Ankita Makol ◽  
Shruthi Kanthaje ◽  
Radha K Dhiman ◽  
Naveen Kalra ◽  
Yogesh K Chawla ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Hepatocellular Carcinoma ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Liver Cirrhosis ◽  
Risk Factor ◽  
Liver Disease ◽  
Prior History ◽  
Number Of Patients

Type 2 diabetes mellitus (T2DM) is a major risk factor associated with hepatocellular carcinoma (HCC). However, the association of T2DM with liver cirrhosis and therapy response in HCC patients is not clear. Hence, in this study, we have evaluated the influence of T2DM on liver cirrhosis severity of HCC and sorafenib response. HCC patients were divided in two groups: T2DM (n = 20) and non-T2DM (nT2DM; n = 50). We found significantly higher number of patients in T2DM group had decompensated liver disease with Child–Turcotte–Pugh score ≥ 7. Additionally, 71.4% patients were observed to be sorafenib sensitive in T2DM group which was significantly higher as compared to 30% in nT2DM group. This study has highlighted the predisposition of HCC patients with T2DM toward more severe liver disease who were found to be better respondents of sorafenib. Impact statement We have explored the association of type 2 diabetes mellitus (T2DM) on liver cirrhosis severity along with response toward sorafenib in hepatocellular carcinoma (HCC). Most HCC patients exhibit prior history of liver cirrhosis that results following long span of chronic liver disease. T2DM constitutes as an important risk factor for HCC development which is known to elevate its incidence. Further, sorafenib is the FDA approved therapy for HCC whose therapeutic outcome is not investigated in HCC patients with T2DM till date. This observation-based study has unveiled a positive association between T2DM and severity of liver cirrhosis as well as sorafenib response in HCC as examined in a clinical setting.

Insulin resistance is not a risk factor for oesophageal varices development in hepatitis C

2019 ◽  
Vol 49 (4) ◽  
pp. 281-285
Author(s):  
Ayman Alsebaey ◽  
Mostafa Elhelbawy
Keyword(s):  
Insulin Resistance ◽  
Risk Factor ◽  
Hepatitis C ◽  
Oesophageal Varices ◽  
Model Assessment ◽  
Homeostasis Model Assessment ◽  
End Stage Liver Disease ◽  
Pugh Class ◽  
End Stage ◽  
The Relationship

Chronic hepatitis C (HCV) patients commonly have insulin resistance which is a risk factor for disease progression. Oesophageal varices may bleed with high mortality. We aimed to assess the relationship between insulin resistance and oesophageal varices. HCV-related compensated liver cirrhosis patients (n = 146) underwent gastroscopy and homeostasis model assessment (HOMA)-IR, HOMA-β and HOMA-S calculations. Their average age was 54.98 years; most (84.9%) patients were men and non-diabetic (60.3%). Patients with oesophageal varices had higher median Model for End-Stage Liver Disease (MELD) scores and comparable Child-Pugh class. Patients with and without oesophageal varices had comparable ( P > 0.05) HOMA scores and insulin resistance percentage of 82.9% versus 85.5%. We therefore conclude that insulin resistance is unrelated to the presence of oesophageal varices.

A simplified multivisceral transplantation procedure for patients with combined end-stage liver disease and type 2 diabetes mellitus

2017 ◽  
Vol 23 (9) ◽  
pp. 1161-1170 ◽  
Author(s):  
Xiao-Shun He ◽  
Shun-Jun Fu ◽  
Qiang Zhao ◽  
Xiao-Feng Zhu ◽  
Dong-Ping Wang ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Liver Disease ◽  
End Stage Liver Disease ◽  
Multivisceral Transplantation ◽  
End Stage

scholarly journals Risk of end-stage liver disease, hepatocellular carcinoma, and liver-related death by fibrosis stage in the hepatitis C Alaska Cohort

Hepatology ◽  
2017 ◽  
Vol 66 (1) ◽  
pp. 37-45 ◽  
Author(s):  
Dana J.T. Bruden ◽  
Brian J. McMahon ◽  
Lisa Townshend-Bulson ◽  
Prabhu Gounder ◽  
Jim Gove ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Disease ◽  
Hepatitis C ◽  
Fibrosis Stage ◽  
End Stage Liver Disease ◽  
End Stage
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