BRANDED CONTENT
Diabetes and non-alcoholic fatty liver disease: Know the risks, symptoms and ways to control it
Around 40 per cent of Singaporeans with diabetes are unaware of the presence of excess fat in their liver which can progress to cirrhosis and liver failure. Here’s how early management can help
Having diabetes increases the risk of developing non-alcoholic fatty liver disease due to insulin resistance, obesity, hypertension and high cholesterol. PHOTO: GETTY IMAGES
Follow topic:
Did you know that as you gain body fat, your liver will collect more fat as well?
Non-alcoholic fatty liver disease (NAFLD) is the excessive accumulation of fat, usually more than 5 per cent, within the liver that is not attributable to alcohol or other drugs.
Beginning with the collection of fat in the liver, NAFLD then progresses to inflammation, which leads to scarring over a prolonged duration. As the scarring progresses, the hardening of the liver – cirrhosis – develops. Also known as end-stage liver disease, cirrhosis can eventually lead to liver damage or failure and in more extreme cases, liver cancer.
Unhealthy weight gain can increase a person’s risk of developing NAFLD. Type 2 diabetes mellitus, which affects millions of people worldwide, is another risk factor, says Dr John Hsiang, senior consultant gastroenterologist at Livingstone Digestive & Liver Clinic located at Mount Elizabeth Medical Centre and Farrer Park Medical Centre.
According to Dr Hsiang, having diabetes increases the risk of developing NAFLD due to insulin resistance, obesity, hypertension and high cholesterol. In particular, insulin resistance brought about by diabetes causes hormone imbalance, resulting in more fatty deposits in the liver and inflammation that leads to scarring.
Furthermore, the presence of diabetes accelerates the progression of NAFLD to liver cirrhosis much faster than those without diabetes.
Spotting the signs of NAFLD
Those with NAFLD are typically asymptomatic in the initial stages. Even if there are symptoms, they may be non-specific such as tiredness and nausea.
It is only when NAFLD progresses to liver cirrhosis that visible signs and symptoms appear, explains Dr Hsiang. These may include fatigue, poor sleep, abdominal distension from fluid collection, weight loss, poor energy levels, jaundice and muscle-wasting.
Those with diabetes, which is a risk factor for NAFLD, will usually be sent for a liver function test by their healthcare provider every six months. However, those without diabetes but have a family history of diabetes, obesity or higher body mass index, should also be screened for NAFLD with a blood test and liver ultrasound.
“They may have silent inflammation and the beginnings of liver scarring which can cause the development of severe NAFLD by the time they are 40 to 50 years old,” he notes.
NAFLD is also associated with other types of organ damage such as heart disease, stroke and chronic kidney diseases. Patients with NAFLD also have an increased risk of colon polyps, colon cancer, liver cancer and pancreatic cancer, adds Dr Hsiang.
How to manage NAFLD in people with diabetes
There is a silver lining for those who have early stage NAFLD. Making lifestyle tweaks such as getting adequate exercise and adopting a healthy diet can improve their condition.
Losing 7 to 10 per cent of body weight can also help to reduce liver inflammation and thus the amount of fat in the liver. While reversal of NAFLD may be possible in some cases, there has to be significant weight loss until the individual’s healthy weight is achieved, says Dr Hsiang.
He recommends any diet, which is rich in nuts, legumes, grains, vegetables, fruits and fish rich in Omega-3, as well as foods rich in polyunsaturated fatty acids. Those who need their daily coffee will rejoice, as the brew is high in antioxidants and contributes to lowering the risk of liver inflammation and liver scarring in NAFLD patients over time, adds Dr Hsiang.
Don’t forget about staying active as well. Dr Hsiang suggests moderate intensity exercises such as brisk walking, taking the stairs, biking or swimming for a total of 140 to 150 minutes per week or at least 30 minutes four times a week.
A class of medications called SGLT2 inhibitors has also been shown to be efficacious for people with fatty liver and diabetes. Although used primarily to treat diabetes, there is evidence to suggest this drug offers an improvement in fatty liver composition and inflammation.
Then there are GLP-1 receptor agonists (GLP-1 RAs), another class of medicines for the treatment of diabetes. Dr Hsiang says these have also shown to reduce weight up to 10 per cent over a 12-month period in trials involving patients with diabetes. By managing blood glucose, there is a positive impact on those with Type 2 diabetes which, in turn, helps to reduce liver fat and inflammation in those with NAFLD.
In addition, he notes that GLP-1 RAs seem to offer other benefits such as lowering the cardiometabolic risk factors and stroke1.
However, caution should be exercised for patients on GLP-1 RAs who have a history of pancreatitis. Some may also be sensitive to the side effects of the medication such as bloating, nausea, some reflux and sometimes constipation.
Always consult your healthcare practitioner before undergoing any medical treatment, adds Dr Hsiang.
With NAFLD becoming a growing public health concern in Singapore, especially with most sufferers being asymptomatic until the later stages, awareness and action are key. What we can do is to adopt a healthier lifestyle and go for regular screenings to prompt early detection.
1Pratley RE, Aroda VR, Lingvay I, et al. Semaglutide versus dulaglutide once weekly in patients with type 2 diabetes (SUSTAIN 7): a randomised, open-label, phase 3b trial. Lancet Diabetes Endocrinol. 2018;6(4):275-286
This is a disease awareness message brought to you by Novo Nordisk. Please consult your healthcare professional in event of any medical query or emergency. Kindly do not attempt to diagnose or self-medicate any medical condition. For more information visit www.novonordisk.sg.
