The Liver and Insulin Resistance: The Important Convergence of Endocrinology and Hepatology

Recognition of a link between insulin resistance (IR) and liver disease dates back at least 100 years to the term “hepatogenous diabetes,” which describes the association between cirrhosis and development of diabetes, and more recently to the term “diabetic fatty liver,” which antedated the now more common terms “nonalcoholic steatohepatitis” (NASH) and “nonalcoholic fatty liver disease” (NAFLD). The ever-rising prevalence of obesity has brought increased attention to these disorders as the hepatic manifestation of “metabolic” or “insulin resistance” syndrome. Indeed, IR appears to be the common link among metabolic syndrome, obesity, and nonalcoholic fatty liver. Metabolic alterations and hepatic steatosis can develop in the insulin-resistant state in the absence of and prior to diabetes mellitus. Moreover, it is now known that IR correlates with increasing fibrosis in other liver diseases including hepatitis C.