Association of non-alcoholic fatty liver disease with cardiovascular disease and all cause death in patients with type 2 diabetes mellitus: nationwide population based study

Korean study (n=7,796,763, of which 6.49% [n=505 763] had diabetes) found non-alcoholic fatty liver disease in patients with type 2 diabetes mellitus seems to be linked to higher risk of cardiovascular disease and all cause death, even in patients with mild degree of fatty liver.

SPS commentary:

Five year absolute risk for cardiovascular disease and all cause death increased in the order of no non-alcoholic fatty liver disease (NAFLD), grade 1 NAFLD, and grade 2 NAFLD in patients without and with type 2 diabetes mellitus (T2DM) as follows:

  • no NAFLD, without T2DM: 1.03, 95% CI 1.02-1.04, and 1.25, 1.24-1.26, respectively
  • grade 1 NAFLD, without T2DM: 1.23, 1.22-1.25, and 1.50, 1.48-1.51, respectively
  • grade 2 NAFLD, without T2DM: 1.42, 1.40-1.45, and 2.09, 2.06-2.12, respectively
  • no NAFLD, with T2DM: 3.34, 3.27-3.41, and 3.68, 3.61-3.74, respectively;
  • grade 1 NAFLD, with T2DM: 3.94, 3.87-4.02, and 4.25, 4.18-4.33, respectively
  • grade 2 NAFLD, with T2DM: 4.66, 4.54-4.78, and 5.91, 5.78-6.05, respectively

An editorial notes the term fatty liver disease was changed to steatotic liver disease, as an umbrella term to include all conditions with evidence of hepatic steatosis, and under the new nomenclature, NAFLD is now referred to as metabolic dysfunction associated steatotic liver disease (MASLD). It points out that MASLD is now recognised as the most prevalent chronic liver disease worldwide and type 2 diabetes is an important risk factor for MASLD, which also seems to accelerate the progression of poor liver and cardiovascular outcomes in patients with MASLD. It discusses the implications for clinical practice of these study findings, and promising results from trials of GLP1RAs and SGLT2 inhibitors to date, but larger studies with clinical end points are needed. It adds that steatotic liver diseases are clearly associated with cardiovascular disease, and nuanced consideration of treatment implications and options are required, especially in people with type 2 diabetes.

British Medical Journal

Resource links:

Editorial