Fatty Liver Disease, A Diabetes Complication, Deserves More Attention

Non-alcoholic fatty liver disease (NAFLD) is a “silent” disease with little or no obvious symptoms.

If you have diabetes, you may have this under radar condition without knowing it: experts estimate that 60-70% of type 2 diabetic patients have it. If you also have obesity, a sedentary lifestyle, or sleep apnea, it can probably be even higher.

No need to worry yet! In most patients with type 2 diabetes, NAFLD only causes moderate metabolic harm, and the results are essentially indistinguishable from other problems that already characterize diabetes. And at this point, the mainstream opinion is that NAFLD should be treated the same way as treating type 2 diabetes. It is a diet, exercise and drug designed to correct insulin resistance.

However, in a small unfortunate number of patients with NAFLD, liver damage progresses to a serious and extremely dangerous level. Recent research suggests that this is a larger problem than previously understood, and experts believe that this condition is worth a lot more attention from both researchers, family doctors and patients than today. In 2023, the American Diabetes Association updated its recommendations to promote more screenings for NAFLD, and it could become increasingly common for clinicians to discuss liver health.

Nonalcoholic fatty liver disease (NAFLD)

Non-alcoholic fatty liver disease refers to the excess accumulation of fat within the liver itself.

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Most people associate liver disease with alcohol abuse, but NAFLD, as the name suggests, is not caused by alcohol. Experts believe that NAFLD is usually caused by the same general factors that cause type 2 diabetes and the metabolic syndrome. It is primarily genetics, age, diet and exercise habits.

NAFLD is highly correlated with metabolic syndrome, defined by visceral fat excess (abdominal excess weight), high triglycerides, low HDL (“good”) cholesterol, hypertension, and insulin resistance. In fact, it may be correct to say that NAFLD is a damage sustained by the liver due to metabolic dysfunction. And like diabetes and metabolic syndrome, NAFLD is on the rise.

Although this condition is often not identifiable, some patients may experience fatigue, nausea, loss of appetite, yellowing, swelling legs, and more.

In part, there is no specific validated treatment for the condition as NAFLD is very strongly linked to other metabolic problems, particularly type 2 diabetes. No drugs are specifically approved for NAFLD, and targeted interventions are not accepted. If you are doing everything you can to treat diabetes and other metabolic problems, you may already be doing everything you can to improve your fatty liver disease.

NAFLD can become serious and scary as it progresses to non-alcoholic steatohepatitis or NASH.

Nonalcoholic steatohepatitis (NASH)

In a small number of patients, NAFLD becomes worse and worse. The liver accumulates more fat, causing inflammation and scarring of liver tissue. At some point, this liver damage qualifies as a new and more serious condition, nonalcoholic steatosis (NASH).

Nash is considered a “progressive and life-threatening disease.” Approximately a quarter of Nash patients experience liver cirrhosis, but liver cancer and liver failure are also a serious and potential problem.

Nash can be difficult to diagnose. In the early stages, some Nash patients strangely remain symptomatic. Doctors rely on a variety of blood tests and imaging techniques, such as ultrasound and MRI, to suggest possible NASH. Liver biopsy – an expensive and highly invasive procedure – is the only way to ensure.

For all these reasons, Nash is often diagnosed only if it is too late to do anything about it. In these unfortunate cases, a liver transplant may be your only option.

Why fatty liver disease deserves more attention

The true extent of its effects has not been well understood so far, as NAFLD is only identified in patients and may not be detected in even NASH.

It began to change. 2021, New England Journal of Medicine We have published a “Prospective Study of Results in Adults with Nonalcoholic Fatty Liver Disease.” Researchers at Commonwealth University of Virginia identified 1,773 patients with NAFLD and organized them according to the severity of liver damage, which lasted for years.

This study proved that patients with NAFLD and NASH can be stratified into more accurate groups according to the amount of fibrosis experienced, giving physicians a useful method to predict patients at higher risk for progressive liver disease. This allows physicians to identify which patients will most benefit from enhanced treatment for metabolic problems.

Meanwhile, there has been a widespread movement to improve the way global medical community approaches the new “epidemic” of liver disease.

Recognizing the lack of professional consensus on these conditions, the American Gastrointestinal Association and seven other professional associations convened an international conference of experts. The results of the meeting were published simultaneously in several scientific journals. Diabetes care July 2021. This article was entitled “Nash’s Preparation for the Evolution: A Call to Action.”

In short, authorities hope that the medical community will take the prevalence of fatty liver very seriously. “The upward trend in incidence and prevalence of NAFLD/NASH highlights the importance and urgency of developing and implementing effective screening, diagnosis and treatment strategies.”

The press release summarises the key findings of it.

• Diabetes is a major risk factor for the progression and severity of NAFLD/NASH
• Primary care providers are the first line of defense and should be trained to identify liver damage early
• Lifestyle Modifications – Diet and Exercise – are the most effective known treatments

Unfortunately, there is no good way to identify NAFLD and NASH early. Participants in the Commonwealth University of Virginia were submitted with liver biopsies. This is an approach that cannot be realistically applied to the general population. Ultrasound is quite good at detecting severe liver disease, but it cannot detect moderate (but worrying) damage.

Instead, doctors can expect to use more and more non-invasive techniques to estimate the degree of liver fibrosis. In the meantime, work continues with new techniques for diagnosing the condition.

Take home

Non-alcoholic fatty liver disease (NAFLD) is thought to be caused by persistent damage to the liver due to metabolic dysfunction. It is very common in adults, especially those with type 2 diabetes. Although it is not necessarily a serious condition in itself, for some patients it progresses to more serious levels of injury known as non-alcoholic steatohepatitis (NASH). Nash can lead to a variety of very bad outcomes, including cirrhosis.

Today, NAFLD screenings are relatively small, and there are no established treatments that go beyond healthy lifestyle guidelines commonly applied to other metabolic conditions such as diabetes, hypertension, and obesity. Authorities want to change the situation and may be years away from effective new screening techniques and treatments, but your medical team may begin to take your liver health more seriously in the near future.