Non‐alcoholic fatty liver disease: more than ‘just a bit of fatty liver’

The prevalence of non‐alcoholic fatty liver disease (NAFLD) is high in the obese, type 2 diabetic population, and it is probably under‐diagnosed as a cause for cirrhosis in this group. We present a case where a lady, with type 2 diabetes mellitus and abnormal liver function tests, was initially reassured that she had ‘just a bit of fatty liver’. When she was found to have liver cirrhosis just three years later, her glycaemic control was tightened up and she was encouraged to lose weight. Despite this she progressed on to develop liver cirrhosis of sufficient severity as to warrant consideration for a liver transplant.

The diagnosis of NAFLD should be considered in patients with type 2 diabetes who have even mildly deranged liver function tests (especially if obese). Urgent prevalence studies for NAFLD in the diabetes population, together with agreed protocols between diabetologists and hepatologists for the investigation and management of this group, are required. Copyright © 2007 John Wiley & Sons.