What Is Non-Alcoholic Fatty Liver Disease?

Learn how insulin resistance and diabetes negatively affect the liver

The leading liver problem in the United States is not alcoholic cirrhosis or hepatitis, but nonalcoholic fatty liver disease (NAFLD). Roughly one in four Americans has the condition.

Although NFLAD is NOT caused by obesity and insulin resistance (a common precursor to type 2 diabetes), it is more common in people with these conditions and more likely to progress to its most serious stages.

At least half of all people with type 2 diabetes are affected by NAFLD, as are up to three-quarters of people who are obese, and 90 percent of people who are morbidly obese.

How NAFLD Develops in People With Type 2 Diabetes

NAFLD is a progressive disease with three distinct stages:

• Stage 1. A simple fatty liver, or steatosis, is characterized by elevations in liver enzymes and fatty deposits in the liver (at least 10 percent of the liver cells are replaced by fat). If the disease is arrested in this stage, it remains relatively benign.
• Stage 2. For one in five patients, the condition progresses to nonalcoholic steatohepatitis, involving inflammation of the liver.
• Stage 3. Half of patients who progress to stage 2 later develop cirrhosis, which is marked by advanced and irreversible scarring, fibrosis, and loss of liver function.

The most significant risk factors for progression include type 2 diabetes and metabolic syndrome.

The common element among both of those disorders is insulin resistance. Elevated insulin levels create metabolic imbalances that drive up blood levels of free fatty acids. This influx of fatty acids overwhelms the liver’s ability to handle them, and they are converted into triglycerides and stored in the organ, setting up a vicious cycle of lipid peroxidation (free-radical damage), inflammation, and liver cell injury.

More Dr. Whitaker Advice on Diabetes Complications

• How to prevent and treat non-alcoholic fatty liver disease
• Innovative clinical therapies for treating diabetes and its complications
• Common diabetes complications