Diabetes ↔ Fatty Liver

Consequence or cause?

It’s no secret that Malta keeps topping the lists for obesity and diabetes rates in EU, with almost a third of the population obese and a tenth of the population suffering from Type 2 diabetes.

Attention has also been shifting to the increasing number of people being diagnosed with fatty liver, medically termed as Non-alcoholic fatty liver disease (NAFLD). This condition is associated with the build up of fat in the liver in the absence of alcohol consumption or other chronic liver diseases. The buildup of fat causes the liver tissue to balloon and inflame resulting in permanent liver damage.

The increase in obesity and diabetes rates, in line with the increase in people being diagnosed with fatty liver, sparked a need to identify the relationship between these diseases. Particularly since, in parallel there is a global shift to a more sedentary lifestyle and unhealthy eating patterns.

With the emerging popularity of the Western diet, studies have shown an increase in consumption of saturated fats, sugars, confectionaries, soft drinks and processed foods, resulting in increased levels of sugar circulating the body and storage of fat in the liver. This pathway is observed in patients suffering from both diabetes and fatty liver.

Having a screening pathway where one refers patients with diabetes for fatty liver screening and vice versa, would therefore aid the chances of earlier detection of both diseases and allow for reversibility.

As part of my Master’s studies I conducted research to correlate the level of sugar in the blood with the level of fat in the liver. As a researcher, I wanted to explore the link between diabetes and fatty liver, and whether one may predict the other.

HbA1c, a marker taken in blood tests to identify the level of sugar in the blood was used, and compared with another marker known as proton density fat-fraction PDFF, which was obtained from a Magnetic Resonance Imaging (MRI) scan of the liver of the same patient. The study was based on 125 patients, of which 78% were found to have fatty liver and 53% were diabetic. The relationship between blood glucose levels and fatty liver was strong indicating that both markers can be a predictor of each other.

In clinical practice, this outcome showed that if a blood test marks high levels of HbA1c, the patient may also be referred for a screening MRI of the liver, since he/she is strongly likely to also have fatty liver. The opposite scenario may occur, whereby a patient diagnosed with fatty liver on MRI, can be also screened for diabetes by taking a blood test.

There’s some good news though, both fatty liver and diabetes (Type 2) are reversible through exercise and diet. Clinical practice guidelines recommend a lifestyle correction to address this problem, whereby patients are advised to engage in some light jogging/ walking or resistance training for at least 2.5hours per week and follow a diet composed of low-to-moderate fat and moderate-to-high carbohydrate intake. For patients with fatty liver that are overweight, studies have shown that a 7-10% weight loss can reduce the amount of fat in the liver.

Below are a few tips:

• Avoid soft drinks at all costs - drink plenty of water instead. For those of you that need some flavour, infuse water with orange and lemon slices, cucumber or mint for an extra kick.
• Avoid consuming processed meat products that are high in saturated fats, opt for fresh meat with minimum processing and fill your plate with fresh vegetables on the side.
• Eat lots of fibre, wholegrains, legumes, brown rice, whole grain pasta, fruit and vegetables. This will help lower your circulating triglyceride levels.
• Include a 30min jog/fast walk for 5 days a week to increase physical activity levels. This may also be in a very simple form to start off, such as parking your car 15 mins away from your place of work and walking back and forth.
• Avoids foods high in saturated fat- Saturated fat intake should be kept to a 10% of the total daily calorie intake. Foods to avoid are fatty cuts of red meat, sausages, butter, coconut oil/cream, chocolate bars, biscuits and cheese particularly cheddar.
• Keep your intake of refined carbs to a minimum. Avoid white pasta, white rice, white potatoes, white bread, sugary breakfast cereals, potato chips.

The take home message is that these metabolic diseases (obesity, diabetes, fatty liver) are all intertwined into the same pathway, all detrimental to the general health of the individual, yet all reversible if the correct action is taken, a little effort is all it takes, get in contact with me to get started.