Can type 2 diabetes mellitus be reversed by improving nonalcoholic fatty liver disease?
-
摘要:
非酒精性脂肪性肝病(NAFLD)使非糖尿病患者新发2型糖尿病(T2DM)风险增加2~3倍,因此,NAFLD人群是一个庞大的T2DM高危人群。在已诊断T2DM人群中,NAFLD患病率高达60%~80%。传统观点认为T2DM是一个终身性疾病,然而近期较多证据支持T2DM是可以缓解的疾病,为T2DM的防治带来了新的曙光。T2DM的缓解取决于合适的治疗手段及时机,肝脏在糖脂代谢中发挥了关键作用,肝脏过多脂肪积聚可引起胰岛素抵抗、肝葡萄糖和甘油三酯输出增多,进而引起胰腺的脂质沉积导致β细胞受损,最终发展为T2DM。生活方式干预治疗在降低肝脂肪含量的同时,可带来糖尿病的缓解或者逆转,NAFLD可作为T2DM的"预警窗口"。因此,以降低肝脂肪含量为目标的治疗方案有望成为预防和逆转糖尿病的良策。
Abstract:Nonalcoholic fatty liver disease( NAFLD) is associated with a 2-to 3-fold increase in the risk of developing type 2 diabetes( T2 DM) in non-diabetic patients,and therefore,the NAFLD population is considered a large population at a high risk of T2 DM. In the population diagnosed with T2 DM,the prevalence rate of NAFLD reaches as high as 60%-80%. T2 DM is considered a lifelong disease in the traditional view,but recently,more and more evidence supports that T2 DM can be reversed,which brings new light to the prevention and treatment of T2 DM. The remission of T2 DM depends on the appropriate treatment methods and timing. The liver plays a key role in glucose and lipid metabolism,and excessive fat accumulation in the liver may induce insulin resistance,increased production of hepatic glucose,and increased triglyceride export,which further leads to fat deposition in the pancreas and beta-cell injury and eventually causes the onset of T2 DM. Lifestyle intervention can reduce liver fat content and achieve the remission or reversal of diabetes,and NAFLD can be regarded as an“early warning window”for T2 DM. Therefore,the treatment regimen aiming at improving liver fat content may become a good strategy to prevent and reverse diabetes.
-
[1] Chinese Society of Endocrinology,Chinese Medical Association. Consensus for diagnosis and treatment of nonalcoholic fatty liver diseases and metabolic disorders(2nd Edition)[J].J Clin Hepatol,2018,34(10):2103-2108.(in Chinese)中华医学会内分泌学分会.非酒精性脂肪性肝病与相关代谢紊乱诊疗共识(第二版)[J].临床肝胆病杂志,2018,34(10):2103-2108. [2] SATTAR N,MCCONNACHIE A,FORD I,et al. Serial metabolic measurements and conversion to type 2 diabetes in the west of Scotland coronary prevention study:Specific elevations in alanine aminotransferase and triglycerides suggest hepatic fat accumulation as a potential contributing factor[J]. Diabetes,2007,56(4):984-991. [3] FRASER A,HARRIS R,SATTAR N,et al. Alanine aminotransferase,gamma-glutamyltransferase,and incident diabetes:The British Women's Heart and Health Study and meta-analysis[J]. Diabetes Care,2009,32(4):741-750. [4] YAN HM,GAO X,LIU M,et al. Study of the association between non-alcoholic fatty liver disease and metabolic syndrome[J]. Chin J Diabetes,2006,14(5):326-328.(in Chinese)颜红梅,高鑫,刘蒙,等.非酒精性脂肪肝与代谢综合征关系的研究[J].中国糖尿病杂志,2006,14(5):326-328. [5] WONG VW,HUI AY,TSANG SW,et al. Prevalence of undiagnosed diabetes and postchallenge hyperglycaemia in Chinese patients with non-alcoholic fatty liver disease[J]. Aliment Pharmacol Ther,2006,24(8):1215-1222. [6] NOBILI V,MANTOVANI A,CIANFARANI S,et al. Prevalence of prediabetes and diabetes in children and adolescents with biopsy-proven non-alcoholic fatty liver disease[J]. J Hepatol,2019,71(4):802-810. [7] FUKUDA T,HAMAGUCHI M,KOJIMA T,et al. The impact of non-alcoholic fatty liver disease on incident type 2 diabetes mellitus in non-overweight individuals[J]. Liver Int,2016,36(2):275-283. [8] AMPUERO J,ALLER R,GALLEGO-DURN R,et al. Significant fibrosis predicts new-onset diabetes mellitus and arterial hypertension in patients with NASH[J]. J Hepatol,2020.[Online ahead of print] [9] BJRKSTRM K,STL P,HULTCRANTZ R,et al. Histologic scores for fat and fibrosis associate with development of type 2diabetes in patients with nonalcoholic fatty liver disease[J].Clin Gastroenterol Hepatol,2017,15(9):1461-1468. [10] NASR P,FREDRIKSON M,EKSTEDT M,et al. The amount of liver fat predicts mortality and development of type 2 diabetes in non-alcoholic fatty liver disease[J]. Liver Int,2020,40(5):1069-1078. [11] MANTOVANI A,BYRNE CD,BONORA E,et al. Nonalcoholic fatty liver disease and risk of incident type 2 diabetes:A Meta-analysis[J]. Diabetes Care,2018,41(2):372-382. [12] American Diabetes Association. Standards of medical care in diabetes—2020[J]. Diabetes Care,2020,43(Suppl 1):s1-s212. [13] CHINESE DIABETES SOCIETY. Guidelines for the prevention and control of type 2 diabetes in China(2017 Edition)[J].Chin J Diabetes Mellitus,2018,10(1):4-67.(in Chinese)中华医学会糖尿病学分会.中国2型糖尿病防治指南(2017年版)[J].中华糖尿病杂志,2018,10(1):4-67. [14] BLOOM A. Remission in diabetes[J]. Br Med J,1959,2(5154):731-734. [15] LEAN MEJ,LESLIE WS,BARNES AC,et al. Durability of a primary care-led weight-management intervention for remission of type 2 diabetes:2-year results of the DiRECT openlabel,cluster-randomised trial[J]. Lancet Diabetes Endocrinol,2019,7(5):344-355. [16] ABBASI J. Unveiling the“magic”of diabetes remission after weight-loss surgery[J]. JAMA,2017,317(6):571-574. [17] ZHYZHNEUSKAYA SV,AL-MRABEH A,PETERS C,et al.Time course of normalization of functionalβ-cell capacity in the diabetes remission clinical trial after weight loss in type 2diabetes[J]. Diabetes Care,2020,43(4):813-820. [18] GOEL A. In type 2 diabetes,a primary care-led weight management program increased weight loss and diabetes remission at 2 years[J]. Ann Intern Med,2019,171(4):jc17. [19] BUSE JB,CAPRIO S,CEFALU WT,et al. How do we define cure of diabetes?[J]. Diabetes Care,2009,32(11):2133-2135. [20] Chinese Diabetes Society Obesity and Diabetes Group. Chinese expert consensus on postoperative management of type2 diabetes treated by metabolic surgery[J]. Chin J Diabetes Mellitus,2018,10(3):161-167.(in Chinese)中华医学会糖尿病学分会肥胖与糖尿病学组.2型糖尿病代谢手术术后管理中国专家共识[J].中华糖尿病杂志,2018,10(3):161-167. [21] STEVEN S,HOLLINGSWORTH KG,AL-MRABEH A,et al.Very low-calorie diet and 6 months of weight stability in type 2diabetes:Pathophysiological changes in responders and nonresponders[J]. Diabetes Care,2016,39(5):808-815. [22] ALLAM MM,EL-ZAWAWY HT. Type 2 diabetes mellitus non-surgical remission:A possible mission[J]. J Clin Transl Endocrinol,2019,18:100206. [23] YAMAZAKI H,TSUBOYA T,TSUJI K,et al. Independent association between improvement of nonalcoholic fatty liver disease and reduced incidence of type 2 diabetes[J]. Diabetes Care,2015,38(9):1673-1679. [24] LAZO M,SOLGA SF,HORSKA A,et al. Effect of a 12-month intensive lifestyle intervention on hepatic steatosis in adults with type 2 diabetes[J]. Diabetes Care,2010,33(10):2156-2163. [25] WILLMANN C,HENI M,LINDER K,et al. Potential effects of reduced red meat compared with increased fiber intake on glucose metabolism and liver fat content:A randomized and controlled dietary intervention study[J]. Am J Clin Nutr,2019,109(2):288-296. [26] GASTALDELLI A,CUSI K. From NASH to diabetes and from diabetes to NASH:Mechanisms and treatment options[J].JHEP Rep,2019,1(4):312-328. [27] TAYLOR R,AL-MRABEH A,ZHYZHNEUSKAYA S,et al. Remission of human type 2 diabetes requires decrease in liver and pancreas fat content but is dependent upon capacity forβcell recovery[J]. Cell Metab,2018,28(4):667. [28] DEFRONZO RA. Banting Lecture. From the triumvirate to the ominous octet:A new paradigm for the treatment of type 2 diabetes mellitus[J]. Diabetes,2009,58(4):773-795. [29] TAYLOR R,AL-MRABEH A,SATTAR N. Understanding the mechanisms of reversal of type 2 diabetes[J]. Lancet Diabetes Endocrinol,2019,7(9):726-736.
计量
- 文章访问数: 429
- HTML全文浏览量: 14
- PDF下载量: 94
- 被引次数: 0