Fatty liver, a "silent killer" among diabetes complications
Non-alcoholic fatty liver disease (NAFLD) or hepatic steatosis, which means "fatty liver," is a common yet often forgotten complication of diabetes. Long-term alcohol abuse is often, also a cause of fatty liver; NAFLD is distinguished from that form of the condition. Non-alcoholic fatty liver disease is actually a broad term that includes two clinically distinct conditions:
- Fat is present in the liver, but no other hepatic alterations are detectable.
- Nonalcoholic steatohepatis (NASH): This is a more serious condition in which the fat induces to changes in the surrounding liver tissue, including inflammation or fibrosis.
Symptoms and diagnosis of NASH
Many people with NASH experience no symptoms, which is why this disease is often called a "silent killer." Symptoms may not occur until liver function is severely compromised and progressing to liver failure.
If symptoms do occur, they may include the following:
- Fatigue or general weakness
- Unexplained weight loss
- A feeling of being "unwell"
- Discomfort in the upper right abdomen, where the liver is located
Three-quarters of people with NASH have an enlarged liver. While a doctor may recommend abdominal ultrasound, CT or MRI scans to determine if fat is building up in the liver, conducting a biopsy is still the only way to confirm the presence of NASH. Plasma bio-markers and new imaging methods point to the possibility of less-invasive diagnosis methods in the near future.
Treating fatty liver and type 2 diabetes, simultaneously
It is estimated that about 70 percent of people with type 2 diabetes also have a fatty liver. According to the National Institutes of Health (NIH), in people with type 2 diabetes, NASH is likely to follow an aggressive course, leading to necroinflammation and fibrosis (e.g. non-functioning, scarred or dead liver tissue).
The principle treatment of diabetes-related NASH is to address risk factors leading to the condition. Losing weight and stopping the consumption of alcohol are important lifestyle changes that can help. The NIH has reported that randomized control studies suggest thiazolidiendiones, a class of drugs already used to treat diabetes, may also offer therapeutic benefits in the treatment of NASH.
As with any life-threatening disease, the best way to beat it is early detection. Talk to your doctor about whether or not you may be at risk for developing NAFLD or NASH.
National Digestive Diseases Information Clearinghouse, "Nonalcoholic Steatohepatitis"
Merck Manuals, "Fatty Liver"
WebMD, "Nonalcoholic Steatohepatitis (NASH)"
Current Opinion in Endocrinology, Diabetes and Obesity, "Nonalcoholic fatty liver disease in type 2 diabetes mellitus"