Hidden Complication of Obesity and Diabetes: Is It Time to Put More Focus on Fatty Liver?

Abstract

Since the release of the EMPA-REG trial in 2015, the focus in diabetes management has been shifted from a glucocentric approach to a more organ-protective approach. Much of the focus has been on cardiorenal protections, thanks to the numerous landmark trials being published in recent years. However, the significance of what seems to be an innocuous fatty deposition in the liver has received less attention than it deserves for many years, especially in people living with diabetes and obesity, but its impact on health has slowly been highlighted more in the last decade. Bodies of research are now suggesting that non-alcoholic fatty liver disease (NAFLD) is a significant independent risk factor for cardiovascular disease, including myocardial infarction, heart failure, and atrial fibrillation, while it carries the increased risk of cirrhosis, hepatocellular carcinoma, and extrahepatic cancers. Numerous organisations have begun to publish guidelines focusing on screening and treating NAFLD in recent years in an effort to combat this underappreciated, underdiagnosed, and undertreated complication of diabetes and obesity. This review paper will provide an overview of NAFLD, highlighting the argument that NAFLD is indeed an independent cardiovascular risk factor, discussing the proposed pathophysiology of NAFLD being a cardiovascular risk factor, and suggesting a highly validated hepatic fibrosis screening tool, which is a simple, easy-to-use tool to screen for hepatic fibrosis, and can be used in primary care offices.