Features of therapeutic options for the treatment of non-alcoholic fatty liver disease and carbohydrate metabolism disorders

Background. Diabetes mellitus is one of the most common diseases worldwide, and non-alcoholic fatty liver disease is recognized as the most common chronic liver disease worldwide. According to current clinical guidelines, non-alcoholic (metabolic dysfunction-associated) steatotic liver disease is a chronic liver condition characterised by macrovesicular steatosis involving at least 5% of hepatocytes. In 75% of cases, non-alcoholic fatty liver disease occurs in the presence of obesity, dyslipidemia, hypertension, type 2 diabetes mellitus, or impaired glucose tolerance. A consistent "bidirectional association" of pathophysiological, epidemiological, and clinical characteristics has been demonstrated between non-alcoholic fatty liver disease and type 2 diabetes. The comorbidity of type 2 diabetes mellitus and non-alcoholic steatotic liver disease doubles the risk of cardiovascular diseases, confers a 2-2.5-fold increased risk of cirrhosis and hepatocellular carcinoma, as well as a 22-fold excess risk of liver-related mortality, compared with the general population. Insulin resistance is a leading factor in the development of non-alcoholic fatty liver disease. Evidence has accumulated indicating that intestinal microflora, bile acid metabolism, and autophagy contribute to the pathogenesis of non-alcoholic fatty liver disease. Clinical manifestations of non-alcoholic fatty liver disease are often absent or mild. In real-world clinical practice, patients present to physicians with complaints related to comorbid conditions associated with non-alcoholic fatty liver disease. Modern approaches to non-alcoholic fatty liver disease treatment are aimed at preventing liver disease progression, regressing steatosis, steatohepatitis, and fibrosis, and reducing cardiometabolic risk factors. It is known that there is a close relationship between non-alcoholic fatty liver disease and carbohydrate metabolism disorders, based on common etiopathogenetic factors.

Conclusion. A multifaceted approach to managing patients with non-alcoholic fatty liver disease and type 2 diabetes, using ursodeoxycholic acid, can be recommended for all forms of non-alcoholic fatty liver disease. At the same time, weight management, physical activity, and dietary changes are effective measures not only for preventing the development of non-alcoholic fatty liver disease but also for reducing the risk of developing and progressing cardiometabolic disorders.

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