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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 fat and insulin resistance (IR) are pivotal factors contributing to NAFLD. NAFLD is not an innocent entity as it not only may cause liver-associated disease but also contributes 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 is still unclear. The utility of non-invasive risk scores to screen for NAFLD in T1D is being explored. Based upon ultrasonographic criteria NAFLD is present in ~22% in adults with T1D. MRI based data show a prevalence rate of ~8.6%. However multiple factors affect these data, ranging from study design and referral bias to discrepancies in diagnostic accuracy.

Subjects with T1D have a 7-fold higher risk of cardiovascular disease (CVD) and CV mortality is the most prominent cause of death in T1D. IR may contribute to NAFLD and to CV complications in T1D. The independent contribution of NAFLD to CV events has to be determined in this population. Furthermore, preliminary data in T1D point towards a 2-3x higher risk for microvascular complications in those with NAFLD.

We will discuss epidemiological and diagnostic challenges of NAFLD in T1D, explore the role of IR in NAFLD and NAFLD-associated complications, and examine the contribution of NAFLD to the presence of macro- and microvascular complications.

Abstract Body

Abstract

Non-alcoholic fatty liver disease (NAFLD) is a metabolic liver disease that is strongly associated with obesity, type 2 diabetes (T2DM) and other metabolic and vascular risk factors. It is now established that NAFLD is a multisystem disease with consequences beyond the liver. NAFLD increases risk of many extra-hepatic diseases such as cardiovascular disease (CVD), chronic kidney disease (CKD) and certain cancers. NAFLD encompasses a spectrum of lipid-associated liver disease and in affected individuals NAFLD may progress from simple steatosis to steatohepatitis, liver fibrosis and cirrhosis. This presentation will discuss the relationships between NAFLD and type 2 diabetes that form part of a vicious cycle of spiralling and worsening metabolic disease. Not only does NAFLD increase risk of developing diabetes with insulin resistance and poor glycaemic control, but development of diabetes further increases risk of worsening liver disease, liver fibrosis and hepatocellular carcinoma. Relationships between NAFLD and cardiovascular disease and the modifying influence on cardiovascular disease of certain genotypes known to increase severity of liver disease will also be discussed.