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Page 6 of 22 Mantovani et al. Hepatoma Res 2020;6:78 I http://dx.doi.org/10.20517/2394-5079.2020.75

Lee et al. [60] 606 South Korean patients with T2DM, aged ≥ 50 years who had undergone Prevalence of NAFLD on
short insulin tolerance test, liver US, and Doppler echocardiography at a specific US was 58.6%
diabetes center were enrolled in the study protocol
2
Mean age 63 years, mean BMI 26 kg/m , 24% males
Seo et al. [61] 4,210 South Korean patients with T2DM were recruited from the Seoul Prevalence of NAFLD on
Metabolic Syndrome Cohort US was 30.4%
Mean age 57 years, mean BMI 25 kg/m2, 51% males
Yeung et al. [62] 1763 Chinese patients with T2DM recruited from the Hong Kong Diabetes Prevalence of NAFLD on
Registry US was 53.2%
2
Mean age 61 years, mean BMI 26 kg/m , 56% males
Bellan et al. [63] 328 Italian patients with T2DM evaluated at a diabetes clinic were offered to Prevalence of NAFLD on
participate in this study, according to the protocol US was 59.5%
2
Mean age 65 years, mean BMI 27 kg/m , 74% males
Tuong et al. [64] 307 Vietnamese patients with T2DM or previously unknown diabetes admitted Prevalence of NAFLD on
for medical check-up US was 73.3%
2
Mean age 57 years, mean BMI 25 kg/m , 54% males
Mantovani et al. [65] 137 Italian patients with non-insulin-treated T2DM and no known liver disease Prevalence of NAFLD on
consecutively attending a diabetes outpatients’ service US was 73.7%
2
Mean age 70 years, mean BMI 28 kg/m , 48% males
Choi et al. [66] 302 South Korean patients with T2DM who underwent regular outpatient clinic Prevalence of NAFLD on
follow-up US was 62%
2
Mean age 58 years, mean BMI 25 kg/m , 38% males
Heidari et al. [67] 255 Iranian patients with T2DM who were referred to some specific endocrine Prevalence of NAFLD on
clinics enrolled in the study by consecutive sampling US was 86.7%
Mean age 51 years, mean BMI 31 kg/m , 32% males
2
Mandal et al. [68] 210 Nepalese patients with T2DM treated as outpatients at a hospital in Nepal Prevalence of NAFLD on
2
Mean age 56 years, mean BMI 29 kg/m , 57% males US was 55.7%
Motta et al. [69] 173 Italian patients with T2DM enrolled in the study by invitation letter Prevalence of NAFLD on
2
Mean age 67 years, mean BMI 30 kg/m , 51% Males US was 24.9%
Sporea et al. [70] 534 Romanian patients with T2DM scheduled for a medical visit at the Prevalence of NAFLD of
Department of Diabetes and Metabolic Diseases who agreed to be evaluated by US was 76%
liver elastography
2
Mean age 61 years, mean BMI 32 kg/m , 47% males
Lombardi et al. [71] 394 Italian outpatients with T2DM attending five Italian diabetes centers Prevalence of NAFLD on
who underwent liver ultrasonography, FibroScan and extensive evaluation of US was 89%
macrovascular and microvascular diabetic complications
2
Mean age 68 years, mean BMI 29 kg/m , 52% Males
Hamid et al. [72] 203 Pakistani patients with T2DM diagnosed during the last 6 months were Prevalence of NAFLD on
enrolled US was 71.9%
Mean age 53 years, 51% males
Lee et al. [73] 1,992 Taiwanese patients with T2DM who participated in a disease management Prevalence of NAFLD on
program at two specialized diabetes outpatient clinics. US was 55.9%
2
Mean age 66 years, mean BMI 26 kg/m , 34% males
El-Ashmawy et al. [74] 270 Egyptian patients with T2DM invited to take part in the study. Prevalence of NAFLD on
Mean age 53 years, mean BMI 26 kg/m , 53% males US was 73.3%
2
Mangla et al. [75] 96 patients with T2DM from USA recruited in a specific area of California who Prevalence of NAFLD on
underwent a research study visit. MRI was 65.6%
2
Mean age 62 years, mean BMI 30 kg/m , 54% males
BMI: body mass index; CT: computed tomography; MRI: magnetic resonance imaging; NAFLD: nonalcoholic fatty liver disease; T2DM:
type 2 diabetes; US: ultrasound
[1-4]
fats) and genetic factors . It is known that overeating, physical inactivity and scarce aerobic fitness are
associated with reduced triglyceride export, increased de novo lipogenesis and increased fatty acid uptake
in the liver [79,80] . All these elements may lead to additional hepatic lipid storage with relevant metabolic
consequences [79,80] . Regarding genetic factors, NAFLD congregates in families with specific variants, such
as patatin-like phospholipase domain-containing 3 gene (PNPLA3) and transmembrane 6 superfamily
[81]
member 2 (TM6SF2) . One of the main genetic variants associated with NAFLD is a mutation [I148M]
[81]
[81]
in PNPLA3 . PNPLA3 plays a key role in hepatic fat accumulation in GG homozygous individuals . In
addition, these patients are at higher risk of developing the more severe forms of NAFLD, independent
[81]
of T2DM . Interestingly, the single variant in the PNPLA3 gene (I148M) has the highest prevalence in
[81]
Hispanics, followed by non-Hispanic whites, Asians, and African Americans .