Non-alcoholic fatty liver disease and type 2 diabetes mellitus: general approaches to the choice of therapy
- 作者: Petunina N.1, Telnova M.1, Goncharova E.1, Martirosian N.1, Kuzina I.1
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隶属关系:
- Sechenov First Moscow State Medical University (Sechenov University)
- 期: 卷 94, 编号 10 (2022)
- 页面: 1155-1162
- 栏目: Original articles
- URL: https://journals.rcsi.science/0040-3660/article/view/111141
- DOI: https://doi.org/10.26442/00403660.2022.10.201921
- ID: 111141
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Currently, there is a growing interest in one of the most common diseases in hepatology – non-alcoholic fatty liver disease (NAFLD). There is evidence that approximately 75% of cases of NAFLD occur against the background of obesity, dyslipidemia or type 2 diabetes mellitus (T2DM). At the present stage, a persistent pathophysiological interaction between NAFLD and T2DM has been demonstrated. Insulin resistance is one of the main pathogenetic causes of the development of T2DM and NAFLD. At the same time, it is necessary to highlight the role of the intestinal microbiota and epigenome in the manifestation and progression of NAFLD. Therefore, treatment approaches should be comprehensive. Diet therapy should be aimed at calorie restriction. However, in real clinical practice, phisicians face a low commitment to appropriate and long-term dietary recommendations necessary for weight loss. At the same time, use of dietary fibers, which are part of the preparation Mucofalk, helps to slow down the passage of food through the digestive tract, increase the saturation period. Use of a low-calorie diet with a significant fat restriction may increase the risk of gallstones. Ursodeoxycholic acid preparations (Ursofalk) can be recommended for the prevention of cholelithiasis. Considering the role of intestinal microflora in the pathogenesis of NAFLD, it is necessary to correct dysbiotic changes as well as basic pharmacotherapy. Thus, a comprehensive approach to the management of patients with NAFLD and T2DM should be aimed not only at therapy, but also at the prevention of associated metabolic disorders.
作者简介
Nina Petunina
Sechenov First Moscow State Medical University (Sechenov University)
Email: milena.telnova@mail.ru
ORCID iD: 0000-0001-9390-1200
чл.-кор. РАН, д-р мед. наук, проф., зав. каф. эндокринологии Института клинической медицины им. Н.В. Склифосовского
俄罗斯联邦, MoscowMilena Telnova
Sechenov First Moscow State Medical University (Sechenov University)
编辑信件的主要联系方式.
Email: milena.telnova@mail.ru
ORCID iD: 0000-0001-8007-9721
кандидат медицинских наук, доцент кафедры эндокринологии им. Н.В. Склифосовского
俄罗斯联邦, MoscowEkaterina Goncharova
Sechenov First Moscow State Medical University (Sechenov University)
Email: milena.telnova@mail.ru
ORCID iD: 0000-0001-7025-8427
канд. мед. наук, доц. каф. эндокринологии Института клинической медицины им. Н.В. Склифосовского
俄罗斯联邦, MoscowNarine Martirosian
Sechenov First Moscow State Medical University (Sechenov University)
Email: milena.telnova@mail.ru
ORCID iD: 0000-0002-0202-1257
канд. мед. наук, доц. каф. эндокринологии Института клинической медицины им. Н.В. Склифосовского
俄罗斯联邦, MoscowIrina Kuzina
Sechenov First Moscow State Medical University (Sechenov University)
Email: milena.telnova@mail.ru
ORCID iD: 0000-0001-7923-4894
ассистент каф. эндокринологии Института клинической медицины им. Н.В. Склифосовского
俄罗斯联邦, Moscow参考
- Лазебник Л.Б., Голованова Е.В., Туркина С.В., и др. Неалкогольная жировая болезнь печени у взрослых: клиника, диагностика, лечение. Рекомендации для терапевтов, третья версия. Экспериментальная и клиническая гастроэнтерология. 2021;185(1):4-52 [Lazebnik LB, Golovanova EV, Turkina SV, et al. Non-alcoholic fatty liver disease in adults: clinic, diagnostics, treatment. Guidelines for therapists, third version. Experimental and Clinical Gastroenterology. 2021;1(1):4-52 (in Russian)]. doi: 10.31146/1682-8658-ecg-185-1-4-52
- Saeedi P, Petersohn I, Salpea P et al. Global and regional diabetes prevalence estimates for 2021 and projections for 2030 and 2045: Results from the International Diabetes Federation Diabetes Atlas, 10(th) edition. Available at: https://diabetesatlas.org/atlas/tenth-edition/ Accessed: 03.10.2022.
- Бакулин И.Г., Сандлер Ю.Г., Винницкая Е.В., и др. Сахарный диабет и неалкогольная жировая болезнь печени: грани сопряженности. Терапевтический архив. 2017;89(2):59-65 [Bakulin IG, Sandler YuG, Vinnitskaya EV, et al. Diabetes mellitus and nonalcoholic fatty liver disease: The verges of contingency. Terapevticheskii Arkhiv (Ter. Arkh.). 2017;89(2):59-65 (in Russian)]. doi: 10.17116/terarkh201789259-65
- Основы гепатологии. Под ред. А.О. Буеверова. М.: Издательский дом «АБВ-пресс», 2022; c. 213-25 [Osnovy gepatologii. Pod red. AO Bueverova. Moscow: Izdatel'skii dom “ABV-press”, 2022; p. 213-25 (in Russian)].
- Буеверов А.О., Рощина К.М., Богомолов П.О. Неалкогольная жировая болезнь печени: новый взгляд на аспекты коморбидности. Эффективная фармакотерапия. 2022;18(6):32-8 [Buyeverov AO, Roshchina KM, Bogomolov PO. Non-Alcoholic Fatty Liver Disease: a New Look at Aspects of Comorbidity. Effektivnaya farmakoterapiya. 2022;18(6):32-8 (in Russian)]. doi: 10.33978/2307-3586-2022-18-6-32-38
- Ивашкин В.Т., Маевская М.В., Павлов Ч.С., и др. Клинические рекомендации по диагностике и лечению неалкогольной жировой болезни печени Российского общества по изучению печени и Российской гастроэнтерологической ассоциации. Гепатология. 2016;2:24-42 [Ivashkin VT, Mayevskaya MV, Pavlov ChS, et al. Diagnostics and treatment of non-alcoholic fatty liver disease: clinical guidelines of the Russian Scientific Liver Society and the Russian gastroenterological association. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2016;2:24-42 (in Russian)]. doi: 10.22416/1382-4376-2016-26-2-24-42
- Бутрова С.А. Метаболический синдром: патогенез, клиника, диагностика, подходы к лечению. РМЖ. 2001;2:56-8 [Butrova SA. Metabolic syndrome: pathogenesis, clinical presentation, diagnosis, treatment approaches. Russkiy Meditsinskiy Zhurnal. 2001;2:56-8 (in Russian)].
- Lonardo A, Lugari S, Ballestri S, et al. A round trip from nonalcoholic fatty liver disease to diabetes: molecular targets to the rescue? Acta Diabetol. 2019;56(4):385-96. doi: 10.1007/s00592-018-1266-0
- Мишина Е.Е., Майоров А.Ю., Богомолов П.О., и др. Неалкогольная жировая болезнь печени: причина или следствие инсулинорезистентности? Сахарный диабет. 2017;20(5):335-43 [Mishina EE, Mayorov AY, Bogomolov PO, et al. Nonalcoholic fatty liver disease: cause or consequence of insulin resistance? Diabetes Mellitus. 2017;20(5):335-43 (in Russian)]. doi: 10.14341/DM9372
- Watt MJ, Miotto PM, De Nardo W, Montgomery MK. The Liver as an Endocrine Organ-Linking NAFLD and Insulin Resistance. Endocr Rev. 2019;40(5):1367-93. doi: 10.1210/er.2019-00034
- Meex RC, Hoy AJ, Morris A, et al. Fetuin B Is a Secreted Hepatocyte Factor Linking Steatosis to Impaired Glucose Metabolism. Cell Metab. 2015;22(6):1078-89. doi: 10.1016/j.cmet.2015.09.023
- Кайбышева В.О., Жарова М.Е., Филимендикова К.Ю., Никонов Е.Л. Микробиом человека: возрастные изменения и функции. Доказательная гастроэнтерология. 2020;9(2):42-55 [Kaibysheva VO, Zharova ME, Filimendikova KYu, Nikonov EL. Human Microbiome: age-related changes and functions. Russian Journal of Evidence-Based Gastroenterology. 2020;9(2):42-55 (in Russian)]. doi: 10.17116/dokgastro2020902142
- Jamaludin M, Nazratun NAH, Zariyantey AH, Budin SB. Mechanisms of Diabetes-Induced Liver Damage. The role of oxidative stress and inflammation. Sultan Qaboos Univ Med J. 2016;16(2):e132-41. doi: 10.18295/squmj.2016.16.02.002
- Castera L. Diagnosis of non-alcoholic fatty liver disease/non-alcoholic steatohepatitis: non-invasive tests are enough. Liver Int. 2018;38(Suppl. 1):67-70. doi: 10.1111/liv.13658
- Kaswala DH, Lai M, Afdhal NH. Fibrosis assessment in nonalcoholic fatty liver disease (NAFLD) in 2016. Dig Dis Sci. 2016;61:1356-64. doi: 10.3126/jpn.v6i11.15679
- Петунина Н.А., Тельнова М.Э. Ожирение: диагностика, подходы к лечению. Учебное пособие. М.: Издательство Сеченовского Университета, 2019; с. 43-52 [Petunina NA, Tel'nova ME. Ozhirenie: diagnostika, podkhody k lecheniiu. Uchebnoe posobie. Moscow: Izdatel'stvo Sechenovskogo Universiteta, 2019; p. 43-52 (in Russian)].
- Онучина Е.В. Новый взгляд на пищевые волокна при метаболическом синдроме. Терапевтический архив. 2018;90(4):85-90 [Onuchina EV. A new look at dietary fibers in metabolic syndrome. Terapevticheskii Arkhiv (Ter. Arkh.). 2018;90(4):85-90 (in Russian)]. doi: 10.26442/terarkh201890485-90
- Киселева Е.В., Демидова Т.Ю. Неалкогольная жировая болезнь печени и сахарный диабет 2 типа: проблема сопряженности и этапности развития. Ожирение и метаболизм. 2021;18(3):313-9 [Kiseleva EV, Demidova TY. Non-alcoholic fatty liver disease and type 2 diabetes mellitus: the problem of conjunction and phasing. Obesity and Metabolism. 2021;18(3):313-9 [(in Russian)]. doi: 10.14341/omet12758
- Zhou J, Massey S, Story D, Li L. Metformin: An Old Drug with New Applications. Int J Mol Sci. 2018;19(10):2863. doi: 10.3390/ijms19102863
- European Association for the Study of the Liver (EASL); European Association for the Study of Diabetes (EASD); European Association for the Study of Obesity (EASO). EASL-EASD-EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease. J Hepatol. 2016;64(6):1388-402. doi: 10.1016/j.jhep.2015.11.004
- Madsbad S. Review of head-to-head comparisons of glucagon-like peptide-1 receptor agonists. Diabetes Obes Metab. 2016;18(4):317-32. doi: 10.1111/dom.12596
- Newsome PN, Buchholtz K, Cusi K, et al. A placebo-controlled trial of subcutaneous semaglutide in nonalcoholic steatohepatitis. N Engl J Med. 2021;384(12):1113-24. doi: 10.1056/NEJMoa2028395
- Ohki T, Isogawa A, Toda N, Tagawa K. Effectiveness of ipragliflozin, a sodium-glucose co-transporter 2 inhibitor, as a second-line treatment for non-alcoholic fatty liver disease patients with type 2 diabetes mellitus who do not respond to incretin-based therapies including glucagon-like peptide-1 analogs and dipeptidyl peptidase-4 inhibitors. Clin Drug Investig. 2016;36(4):313-9. doi: 10.1007/s40261-016-0383-1
- Mantovani A, Petracca G, Csermely A, et al. Sodium-glucose cotransporter-2 inhibitors for treatment of nonalcoholic fatty liver disease: a meta-analysis of randomized controlled trials. Metabolites. 2020;11(1):22. doi: 10.3390/metabo11010022
- Hartstra A, Bouter KE, Bäckhed F, Nieuwdorp M. Insights Into the Role of the Microbiome in Obesity and Type 2 Diabetes. Diabetes Care. 2015;38:159-65. doi: 10.2337/dc14-0769
- Coppola S, Avagliano C, Calignano A, Berni Canani R. The Protective Role of Butyrate against Obesity and Obesity-Related Diseases. Molecules. 2021;26:682. doi: 10.3390/molecules26030682
- Roshanravan N, Mahdavi R, Alizadeh E, et al. Effect of Butyrate and Inulin Supplementation on Glycemic Status, Lipid Profi le and Glucagon-Like Peptide 1 Level in Patients with Type 2 Diabetes: A Randomized Double-Blind, Placebo-Controlled Trial. Horm Metab Res. 2017;49(11):886-91. doi: 10.1055/s-0043-119089
- Звенигородская Л.А. Неалкогольная жировая болезнь печени: эволюция представлений, патогенетические акценты, подходы к терапии. Трудный пациент. 2015;10-11:37-43 [Zvenigorodskaya LA. Non-alcoholic fatty liver disease: the evolution of ideas, pathogenetic accents, approaches to therapy. Trudny Patsient. 2015;10-11:37-43 [(in Russian)].
- Казюлин А.Н. Место урсодезоксихолевой кислоты в терапии неалкогольной жировой болезни печени на разных стадиях заболевания: стеатоз, стеатогепатит, фиброз/цирроз. Русский медицинский журнал. 2017;17:1248-57 [Kazyulin AN. The role of ursodeoxycholic acid in the treatment of non-alcoholic fatty liver disease at different stages of the disease: steatosis, steatohepatitis, fibrosis/cirrhosis. Russkii meditsinskii zhurnal. 2017;17:1248-57 [(in Russian)].
- Надинская М.Ю. Исследование применения урсодеоксихолевой кислоты в гепатологии с позиции медицины, основанной на научных доказательствах. Consilium Medicum. 2003;5(6):318-22 [Nadinskaya MYu. The study of the use of ursodeoxycholic acid in hepatology from the perspective of medicine based on scientific evidence. Consilium Medicum. 2003;5(6):318-22 [(in Russian)].
- Махов В.М., Угрюмова Л.Н., Балахонов А.А., Мамиева З.А. Урсодезоксихолевая кислота: взгляд терапевта. Медицинский совет. 2017;15:112-6 [Makhov VM, Ugryumova LN, Balakhonov AA, Mamieva ZA. Ursodeoxycholic acid: a view of the therapist. Meditsinskiy sovet. 2017;15:112-6 (in Russian)]. doi: 10.21518/2079-701X-2017-15-112-116
- Sánchez-García A, Sahebkar A, Simental-Mendía M, Simental-Mendía LE. Effect of ursodeoxycholic acid on glycemic markers: A systematic review and metaanalysis of clinical trials. Pharmacol Res. 2018;135:144-9. doi: 10.1016/j.phrs.2018.08.008
- Liu J, Lu H, Lu YF, et al. Potency of individual bile acids to regulate bile acid synthesis and transport genes in primary human hepatocyte cultures. Toxicol Sci. 2014;141:538-46. doi: 10.1093/toxsci/kfu151
- Ozel Coskin BD, Yucesov M, Gursoy S, et al. Effects of ursodeoxycholic acid therapy on carotid intima media thickness, apolipoprotein A1, apolipoprotein B, and apolipoprotein B/A1 ratio in nonalcoholic steatohepatitis. J Gastroenterol Hepatol. 2015;27(2):142-9. doi: 10.1097/MEG.0000000000000264
- Mueller M, Thorrel A, Claudel T, et al. Ursodeoxycholic acid exerts farnesoid X receptorantagonistic effects on bile acid and lipid metabolism in morbid obesity. J Hepatol. 2015;62(6):1398-404. doi: 10.1016/j.jhep.2014.12.034
- Shima KR, Ota T, Kato KI, et al. Ursodeoxycholic acid potentiates dipeptidyl peptidase-4 inhibitor sitagliptin by enhancing glucagon-like peptide-1 secretion in patients with type 2 diabetes and chronic liver disease: a pilot randomized controlled and add-on study. BMJ Open Diab Res Care. 2018;6. doi: 10.1136/bmjdrc-2017-000469
- Wu Z, Xie Y, Morrison RF, et al. PPARγ induces the Insulin-dependent Glucose Transporter GLUT4 in the absence of C/ЕВРα during the conversion of 3T3 fibroblasts into adipocytes. J Clin Invest. 2017;101:22-32. doi: 10.1172/JCI1244
- Ratziu V, de Leding hen V, Oberti F, et al. A randomized controlled trial of high-dose ursodesoxycholic acid for nonalcoholic steatohepatitis. J Hepatol. 2011;54(5):1011-9. doi: 10.1016/j.jhep.2010.08.030