Features of type 2 diabetes combined with metabolic dysfunction-associated fatty liver disease under conditions of chronic stress

Background. Metabolic-associated fatty liver disease (MAFLD) is the most common chronic liver disease in which the main pathogenic processes originate from metabolic dysfunction. In recent years, MAFLD has acquired the nature of an epidemic, which is closely related to the epidemic of obesity, type diabetes mellitus (T2DM) and a significant increase in the risk of cardiovascular diseases. Along with the known pathogenetic factors outlined in the “multiple parallel hits” hypothesis, in the context of the COVID-19 pandemic and the russian military aggression in Ukraine, an additional powerful pathogenetic factor that can affect the course of many diseases, including MAFLD, is chronic stress. The aim of the study is to identify the clinical and biochemical features of MAFLD against the background of T2DM under the conditions of military stress in Ukraine. Materials and methods. We conducted a comparative study on the features of the course of MAFLD in 64 participants with T2DM: the first group — 44 individuals who were constantly under martial law in Ukraine, and controls — 20 patients who returned to Ukraine after a long (over 12 months) stay abroad. Results. The research shows that patients with MAFLD, who were affected by the negative consequences of military actions, had a statistically significant increase in the level of fasting glucose and markers of insulin resistance, an increase in the activity of liver transaminases and the level of markers of systemic inflammation compared to the pre-war period. The negative impact of wartime stress factors causes diabetic distress and a more severe course of MAFLD, which can subsequently lead to rapid progression of the disease. Most patients of the first group reported significant changes in the psycho-emotional state. The most common were low mood (81.8 %), feeling of anxiety/fear (79.5 %), sleep disturbances (81.8 %), general weakness and quick fatigue (63.3 %), which occurred much more often and were more pronounced than in the control group. Conclusions. During active military operations, epigenetic factors such as changes in the regime and quality of nutrition, psycho-emotional disorders in the form of astheno-neurotic and anxiety-depressive disorders, post-traumatic stress disorders, war-related unemployment and other negative factors become of great importance. Therefore, in these patients, control of optimal levels of glycemia, indicators of liver tests and lipid spectrum, as well as the state of mental health, are very significant.