April 8, 2015

Fatty Liver Disease – Part 1

This topic is not what I thought and research has given me cause for concern. Fatty liver disease is not to be taken lightly or even dismissed. Diabetes and liver disease is by far worse than alcohol and liver cirrhosis. Whether you believe it or not, diabetes is now the most common cause of liver disease in the United States. Cryptogenic cirrhosis which is cirrhosis of unknown etiology, with no history of alcoholism or previous acute hepatitis has made diabetes the third leading indicator for liver transplantation.

Diabetes raises your risk of nonalcoholic fatty liver disease (NAFLD), a condition in which excess fat builds up in your liver even if you drink little or no alcohol. This condition occurs in at least half of those with type 2 diabetes and close to half of those with type 1 diabetes. Other medical conditions, such as obesity, high cholesterol, and high blood pressure, also raise your risk of nonalcoholic fatty liver disease. Fatty liver disease itself often causes no symptoms. But it raises your risk of developing liver inflammation or scarring (cirrhosis). It's also linked to an increased risk of liver cancer and heart disease.

Fatty liver disease may have played a role in the development of your type 2 diabetes initially. Once you have both conditions, poorly managed type 2 diabetes can make fatty liver disease worse.

Your best defense against fatty liver disease includes these strategies:
  • Work with your health care team to achieve good control of your blood sugar.
  • Lose weight if you need to, and try to maintain a healthy weight.
  • Take steps to reduce high blood pressure.
  • Keep your low-density lipoprotein (LDL, or "bad") cholesterol and triglycerides — a type of blood fat — within recommended limits.
  • Don't drink too much alcohol.

If you have diabetes, your doctor may recommend an ultrasound examination of your liver when you're first diagnosed and regular follow-up blood tests to monitor your liver function.

Make sure that your non-alcoholic fatty liver disease is treated rather than letting it progress to non-alcoholic steatosis, a potential lethal condition. About seven out of 10 people with type 2 diabetes have a fatty liver. Learn how to treat or prevent this complication.

Who gets non-alcoholic fatty liver disease and why? Although researchers have tried to pin this on different ethnicities, this has not been successful. The only common denominator is obesity and this holds true regardless of ethnic background.

The severity of type 2 diabetes and the type and severity of liver disease influence the therapy. There are few clinical trials that specifically target patients with coexistent diabetes and liver disease, and all are limited by small numbers of patients.

Heart disease is the leading cause of morbidity and mortality in both Type 2 diabetes and NAFLD. Individuals with diabetes demonstrate a 74% greater risk of hospitalization due to heart failure. NAFLD, characterized by elevated serum γ-glutamyltransferase (GGT), is independently associated with heart failure. The increased incidence of cardiovascular morbidity and mortality associated with Type 2 diabetes and NAFLD, has been linked to preclinical changes in cardiac structure, function, and metabolism.

Using magnetic resonance imaging (MRI) we have previously shown pre-clinical changes in cardiac structure and function in NAFLD. To extent this work and in light of the importance of understanding early cardiac changes and reducing cardiovascular risk in people with metabolic disease, the study was designed to compare the impact of Type 2 diabetes and NAFLD upon cardiac structure, function, and metabolism and to identify potential metabolic mediators.

Changes in cardiac structure are evident in adults with Type 2 diabetes and NAFLD without overt cardiac disease and without changes in cardiac energy metabolism. The growing prevalence of metabolic disorders puts large numbers at risk of these underlying cardiac changes. Only the Type 2 diabetes group display diastolic and subendocardial dysfunction and glycemic control may be a key mediator of these cardiac changes. Managing blood glucose should therefore be a priority for clinical care teams to prevent cardiac complications in adults with Type 2 diabetes and NAFLD.

Continued in the following blogs.

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