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A growing number of published papers consider the nonalcoholic fatty liver disease (NAFLD) and cryptogenic cirrhosis as the immediate offspring of Type 2 diabetes mellitus (T2DM). NAFLD is the most common liver disorder in developed countries, where up to 80% of obese people have the disease. Cirrhosis is defined as the advanced stages of hepatic fibrosis with characteristic distortion of hepatic architecture in addition to numerous regenerative nodules. Cirrhosis without an apparent cause (eg, alcoholic liver disease, viral hepatitis B & C, autoimmune hepatitis, Wilson’ s disease and so on ....) has been labeled as cryptogenic [1,2]. After presentation and identification of metabolic syndrome as a distinct clinical entity and its final outcome, that is T2DM, the surging prevalence of NAFLD and cryptogenic cirrhosis was considered as a direct complication of T2DM [3-9]. In a study conducted by Younossi, of 132 patients with NAFLD, 44 subjects (33%) were reported to have established T2DM [10]. Of those fortyfour diabetic patients with NAFLD, 11 were reported to be affected by frank cryptogenic cirrhosis. Going through the paper, the reader would immediately suppose that, one out of three type 2 diabetic patients have had concomitant end-stage cirrhosis of the liver. In a review article, Cusi K. proceeded further up and stated that approximately 70% of T2DM patients had fatty liver, and the non-alcoholic steatohepatitis was suggested as the leading cause of endstage liver disease in persons with T2DM.The author eventually concluded as if the NASH is the straightforward “complication” of T2DM!! [11].

Non-Alcoholic Fatty Liver Disease, Cryptogenic Cirrhosis and Type-2 Diabetes Mellitus: How are They Related?!