In what could be seen as the latest efforts to control the manifestation of non-alcoholic fatty liver disease (NAFLD) among those diagnosed with type 2 diabetes, the American Diabetes Association (ADA) has called out for the screening of all those with this diabetes variant to undergo liver screening to assess whether they have excess fatty deposits on their liver. The ADA, in the last week of June, tweaked its guidelines for diabetes care recommending more stringent screening for people with symptoms of diabetes and non-alcoholic fatty liver disease
“Diabetes and liver diseases are closely linked, and it is essential that healthcare professionals have the most current information to effectively detect and manage this disease,” says Dr Nuha ElSayed, endocrinologist and overseer, standards of care guidelines committee (ADA) in an official statement.
Diabetes and non-alcoholic fatty liver disease
The ADA points out that liver disease affects up to 70 per cent of people with diabetes and is one of the most serious diabetes-triggered complications. Dr Krishnan Swaminathan, a Coimbatore-based endocrinologist and researcher points out the same and adds that diabetes, obesity, NAFLD and NASH (nonalcoholic steatohepatitis) are often found to be part of one unhealthy circle.
“People with type 2 diabetes especially those who are obese, are at higher risk of NAFLD and NASH,” Dr Swaminathan says.
Excess calorie intake and lack of physical activity end up in the deposition of visceral fat deposits in organs including the liver and pancreas setting the stage for fatty liver disease. This excess fat deposits on abdominal organs, mainly the pancreas eventually end up affecting insulin secretion, thus affecting glucose metabolism. It also eventually leads to inflammation and scarring in the liver which triggers hepatic insulin resistance, further crippling blood glucose management and increasing the risk of diabetes. Excess abdominal fat is also considered a sure-shot indicator of the high risk of type 2 diabetes.
“Due to the high risk of liver diseases in people with diabetes, it is often advised that they undergo annual liver function test and also opt for an ultrasound scan if there is any cause of concern in these tests,” Dr Swaminathan adds.
Fructose and high triglycerides in fatty liver disease
Unlike glucose, fructose, another form of natural sugar found in ultra-processed food from ketchup to cereals, in the form of high fructose corn syrup cannot be broken down by insulin. It is metabolised in the liver.
“The liver produces enzymes which break down fructose into triglycerides to be used by the body as our cells cannot directly deal with fructose. In the case of a person who consumes excess processed food and has a sedentary lifestyle, there will be an excess of triglyceride as the body stores excess fat for later use in liver and fat cells,” says Dr Praveen CR, senior consultant, general GI and laparoscopic surgeon, Manipal Hospitals, Varthur, Bengaluru.
Triglycerides and fatty liver disease
Apart from glucose, impaired lipid metabolism also leads to excess fat deposition on the liver especially in the case of obese people with type 2 diabetes.
“When it comes to the liver health of people with type 2 diabetes, we ask them to lose weight through lifestyle and dietary alteration to take care of fat deposition on the liver,” says Dr Neeraj Dhamija, gastrointestinal surgeon, Sir Ganga Ram Hospital, New Delhi.
Dr Dhamija also adds that people diagnosed with diabetes will not be able to break down glucose and use it to fuel up the cells for various physiological processes due to either the lack of insulin or insulin resistance.
“In the absence of insulin activity, there will be no way for the cells to get energy from glucose, forcing the body to resort to further measures – the synthesis of fat – which will further lead to the release of fatty acids into the blood,” he adds.
High triglycerides, a warning for liver problems
Excess fat deposition on your liver is initially diagnosed as NAFLD and it doesn’t have any overt symptoms. However, in a bit more advanced stage, when inflammation sets in and starts damaging liver cells, it is often referred to as non-alcoholic steatohepatitis. Symptoms become visible only after the liver tissues become inflammed.
“This stage will be followed by fibrosis and cirrhosis of the liver. Once the inflammation sets in, the liver will not be able to synthesise triglycerides properly and a high level of triglycerides could be a symptom of fatty liver,” Dr Praveen adds.
Dr Dhamija says that not all forms of fatty liver would lead to inflammation and liver scarring if they are diagnosed at an early stage.
According to the International Diabetes Federation (IDF), as many as 537 million people are living with diabetes across the globe. Studies also indicate that about one-third to two-thirds of people with diabetes are also affected by NAFLD.
Takeaways
The American Diabetes Association (ADA) has revised its diabetes care guidelines and has called for the screening of all people with type 2 diabetes for NAFLD also. It has been pointed out that NAFLD has emerged as one of the most prominent complications of diabetes. Since the initial stages do not have any overt symptoms, experts point out that early detection followed by lifestyle and dietary alterations would help keep your liver in good health.
