الفهرس 
Type 2 Diabetes MellitusOnly 14 pages are availabe for public view
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Abstract
Metabolic associated fatty liver disease (MAFLD) is a clinical
pathological syndrome and one of its key characteristics is hepatic steatosis
which can be caused by excessive accumulation of fat in the liver, The criteria
of (MAFLD) are based on evidence of hepatic steatosis, in addition to one of
the following three criteria, namely overweight/obesity, presence of type 2
diabetes mellitus, or evidence of metabolic disorders. The disease spectrum
includes Metabolic associated steatosis (MAS), Metabolic associated
steatohepatitis (MASH), liver fibrosis and liver cancer.
A meta-analysis of 35,599 patients with type 2 diabetes mellitus (T2DM)
from 6 countries indicated that the prevalence of MAFLD was 59.67%.
Metabolic associated fatty liver disease (MAFLD) can significantly
increase the prevalence of chronic complications in patients with T2DM, on the
other hand, T2DM can stimulate the development from MAFLD to MASH and
make it easy to progress to liver fibrosis.
Nowadays, liver biopsy is the “gold standard” in diagnosing MAFLD and
progressive liver disease. However, liver biopsy is an invasive approach, so
Angulo et al. recommended the use of MAFLD liver fibrosis score as
preliminary evaluation of liver fibrosis is a non-traumatic liver fibrosis scoring
system and MFS > 0.676 is usually used as marker of progressive liver fibrosis.
These patients with MFS > 0.676 are prone to progression of cirrhosis or even
liver cancer while MFS < -1.455 is the exception to progressive liver fibrosis.
However, MFS is rarely investigated in T2DM patients, and most studies were
based on the use of color ultrasound which can only identify AFLD with liver
fat content greater than 30%.
Zhang et al. pointed out that the liver fat content of T2DM patients
decreased while the liver fibrosis score was higher in these patients, suggesting
that the use of liver color ultrasound diagnosis may underestimate the
occurrence of MAFLD. Therefore, it is necessary to find other strategy for
effective assessment of MAFLD in T2DM patients. The liver plays a crucial
role in the metabolism of cholesterol and triglycerides (TG). Meanwhile,
thyroid hormones interact on hepatic lipid homeostasis through multiple
pathways, including stimulation of free fatty acid delivery to the liver for
reesterification to TG, and increasing fatty acid β-oxidation, thereby affecting
hepatic fat accumulation. Lower thyroid hormone level can increase blood
lipids and increase the prevalence of MAFLD. Byrne et al. pointed out that
hypothyroidism was a key element for the occurrence of MAFLD. In contrary,
Lee et al. pointed out that hypothyroidism was not correlated with the
occurrence of MAFLD.
Van den Berg et al. studied people with normal thyroid function and
concluded that the free triiodothyronine (FT3) of MAFLD patients was very
high, and free thyroxine (FT4) was very low. Kim et al. found subclinical
hypothyroidism was one of the independent factors for progressive liver
fibrosis. Recent studies indicated an association between thyroid hormone and
liver level of triglyceride in T2DM patients. These studies suggested the
necessity to clarify the relationship between thyroid hormones with MAFLD,
particularly for these T2DM patients the association between the thyroid
hormones and Metabolic associated fatty liver disease (MAFLD) in type 2
diabetes mellitus (T2DM) Egyptian patients is not clear yet.
The objective of this study was to analyze the association between the
thyroid hormones and Metabolic associated fatty liver disease (MAFLD) in type 2 diabetes mellitus (T2DM) Egyptian patients.