Fatty Liver and Diabetes
Nonalcoholic fatty liver refers to a group of conditions wherein the liver accumulates fat, which
leads to the inflammation of storage cells in the liver and the enlargement of the liver itself.
Roughly one fourth of all Americans have fatty liver, and some experts believe that 50%–70% of
all people with diabetes will develop it.
Having fatty liver is an independent risk factor for developing diabetes. In one study, people with
fatty liver were five times more likely to develop diabetes. In some people, fatty liver develops
into nonalcoholic steatohepatitis (NASH), a serious condition that can permanently damage the
liver and lead to the development of cirrhosis or liver failure.
Risk factors
Risk factors for the development of fatty liver include:
 Use of some medications
 Gastric bypass surgery
 Hyperlipidemia
 Malnutrition
 Metabolic syndrome
 Obesity
 Rapid weight loss or malnutrition
 Toxins and chemicals
 Having type 2 diabetes or Wilson’s disease
Tests
Liver enzymes, usually part of routine blood work, are elevated in people with fatty liver.
Doctors will order imaging studies of the liver, and possibly a liver biopsy, if they suspect that
you may have fatty liver.
Recommendations
Rapid weight loss can cause more liver damage, so most experts recommend losing about 1
pound/week, along with initiation of an exercise regimen. Ask your doctor to re-evaluate the
necessity of your medications and stop using any that are deemed unnecessary.
Taking steps to reduce blood pressure, low-density lipoprotein cholesterol (LDL), and
triglycerides is important. It is estimated that 70% of people with NASH also have concurrent
dyslipidemia. People who are diagnosed with fatty liver should abstain from alcohol.
Medications
Metformin, Actos®, Avandia®, and Starlix®, medications which many people with diabetes
already take, appear to help in the treatment of fatty liver.
Glucose control
Tight glucose control is especially important for people diagnosed with fatty liver.
Antioxidants
Antioxidants, such as vitamin C, vitamin E, N-acetylcysteine, alpha lipoic acid, selenium, and
betaine may help, although research is not conclusive and the ideal combination is not yet
confirmed.
Magnesium
Magnesium also is correlated with improvement of fatty liver in some studies. A low-serum level
of magnesium is a symptom of fatty liver and is possibly a risk factor in the progression of fatty
liver to NASH.
Supplements
Always talk to your doctor before beginning to take any dietary supplements.
References and recommended readings
Bledsoe A. Type 2 diabetes and fatty liver disease. Available at:
http://www.everydayhealth.com/type-2-diabetes/fatty-liver-disease-connection.aspx. Accessed
June 8, 2012.
Collazo-Clavell M. Diabetes: how do I protect my liver? Available at:
http://www.mayoclinic.com/health/diabetes/AN00193. Accessed June 8, 2012.
Dinsmoor RS. Fatty liver. Available at:
http://www.diabetesselfmanagement.com/Articles/Diabetes-Definitions/fatty_liver/. Accessed
June 8, 2012.
Foster T, Budoff MJ, Saab S, Ahmadi N, Gordon C, Guerci AD. Atorvastatin and antioxidants
for the treatment of nonalcoholic fatty liver disease: the St. Francis Heart Study randomized
clinical trial. Am J Gastroenterol [serial online]. 2011;106:71-77. Available at:
http://www.med.upenn.edu/gastro/documents/ajg2010299a.pdf. Accessed June 8, 2012.
Mehta K, Van Thiel DH, Shah N. Mobarthan S. Nonalcoholic fatty liver disease: pathogenesis
and the role of antioxidants. Nutr Rev [serial online]. 2002;60:289-293. Available at:
http://www.ncbi.nlm.nih.gov/pubmed/12296456. Accessed June 8, 2012.
Mendosa D. Fatty liver. Available at: http://www.healthcentral.com/diabetes/c/17/1363/fattyliver. Accessed June 8, 2012.
ScienceDaily®. Fatty liver may herald impending type 2 diabetes. Available at:
http://www.sciencedaily.com/releases/2011/02/110224091613.htm. Accessed June 8, 2012.
Turecky L, Kupcova V, Szantova M, Uhlikova E, Viktorinova A, Czirfusz A. Serum magnesium
levels in patients with alcoholic and non-alcoholic fatty liver. Bratisl Lek Listy [serial online].
2006;107:58-61. Available at: http://www.ncbi.nlm.nih.gov/pubmed/16796125. Accessed June
8, 2012.
Warner J. Fatty liver may be linked to diabetes risk: study shows people with fatty liver disease
have increased risk of type 2 diabetes. Available at:
http://diabetes.webmd.com/news/20110225/fatty-liver-may-be-linked-to-diabetes-risk. Accessed
June 8, 2012.
Yin S. Combination antioxidant therapy may help fatty liver. Abstract presented at the American
College of Gastroenterology (ACG) Annual Scientific Meeting and Postgraduate Course;
November 3, 2011; Washington, DC. Abstract 38. Available at:
http://www.medscape.com/viewarticle/753034. Accessed June 8, 2012.
Contributed by Elaine Koontz RD, LD/N
Review Date 6/12
D-0593