Non-alcoholic fatty liver disease (NAFLD), also known as fatty liver or hepatic steatosis, is a common complication of type 2 diabetes in which excess fat accumulates in the liver. Without treatment, it can progress to fibrosis, cirrhosis, and even liver cancer.
1. Why Does Diabetes Lead to Fatty Liver Disease?
🔹 Main mechanisms of development:
✔ Insulin resistance – the liver becomes less responsive to insulin and increases the production of glucose and triglycerides.
✔ Oxidative stress – excess free fatty acids damage liver cells.
✔ Inflammation – promotes the progression from simple steatosis to steatohepatitis (NASH).
🔹 Risk factors:
Obesity (especially abdominal obesity)
Elevated triglycerides and LDL cholesterol
Sedentary lifestyle
Poorly balanced diet
2. Symptoms and Diagnosis
🔸 Early stages (often asymptomatic):
Heaviness or discomfort in the right upper abdomen
Increased fatigue
Mild enlargement of the liver
🔸 Advanced manifestations:
Jaundice
Spider veins on the skin
Ascites (in cases of cirrhosis)
🔹 Diagnostic methods:
✔ Blood tests (ALT, AST, GGT, alkaline phosphatase)
✔ Liver ultrasound (detects steatosis)
✔ FibroScan (elastography) – assesses liver tissue stiffness
✔ Liver biopsy (gold standard for diagnosing NASH)
3. Treatment: How to Protect the Liver
✅ Basic measures (most effective):
✔ Weight loss of 5–10% – significantly reduces fat accumulation in the liver.
✔ Low glycemic index diet (fewer fast carbohydrates, more fiber).
✔ Regular physical activity (150 minutes/week of cardio plus strength training).
✅ Medications:
Metformin – improves hepatic insulin sensitivity.
Thiazolidinediones (pioglitazone) – reduce liver inflammation (but may cause weight gain).
Vitamin E (antioxidant) – only as prescribed by a physician.
Ursodeoxycholic acid – for associated cholestasis.
❌ What worsens fatty liver disease?
Alcohol (even in small amounts!)
Fructose (fruit juices, sweetened beverages)
Rapid weight loss (>1.5 kg per week)
4. Prevention of Complications
✔ Maintaining HbA1c below 7% – reduces fibrosis progression.
✔ Regular monitoring of liver enzymes (every 6–12 months).
✔ Vaccination against hepatitis B (infection risk is higher in people with diabetes).
Conclusion
Fatty liver disease in type 2 diabetes is a “silent” companion that requires attention. The keys to success are weight reduction, control of blood glucose and lipids, and avoidance of harmful habits.
Important: Even in the absence of symptoms, have your liver checked annually. Early intervention helps prevent irreversible damage.