Progression of NAFLD to diabetes mellitus, cardiovascular disease or cirrhosis

Nat Rev Gastroenterol Hepatol. 2013 Jun;10(6):330-44. doi: 10.1038/nrgastro.2013.41. Epub 2013 Mar 19.


NAFLD is a spectrum of progressive liver disease that encompasses simple steatosis, NASH, fibrosis and, ultimately, cirrhosis. NAFLD is recognized as the hepatic component of the metabolic syndrome, as these conditions have insulin resistance as a common pathophysiological mechanism. Therefore, NAFLD is strongly associated with type 2 diabetes mellitus and abdominal obesity. As lifestyles have become increasingly sedentary and dietary patterns have changed, the worldwide prevalence of NAFLD has increased dramatically and is projected to be the principal aetiology for liver transplantation within the next decade. Importantly, a growing body of clinical and epidemiological evidence suggests that NAFLD is associated not only with liver-related morbidity and mortality, but also with an increased risk of developing both cardiovascular disease and type 2 diabetes mellitus. This article reviews the evidence that suggests NAFLD is a multisystem disease and the factors that might determine interindividual variation in the development and progression of its major hepatic and extrahepatic manifestations (principally type 2 diabetes mellitus and cardiovascular disease).

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Carcinoma, Hepatocellular / epidemiology
  • Cardiovascular Diseases / epidemiology*
  • Diabetes Mellitus, Type 2 / epidemiology*
  • Disease Progression*
  • Fatty Liver / complications*
  • Fatty Liver / epidemiology
  • Humans
  • Liver Cirrhosis / epidemiology*
  • Liver Neoplasms / epidemiology
  • Non-alcoholic Fatty Liver Disease
  • Prevalence
  • Risk Factors
  • Severity of Illness Index