In middle-aged obese patients with type 2 diabetes, the presence of non-alcoholic fatty liver disease (NAFLD) is associated with more adverse health effects compared to people without NAFLD, research suggests.
NAFLD is a condition which involves a build-up of fat within the liver and increases the risk of cardiovascular problems, such as heart attack. It is particularly dangerous for people with type 2 diabetes who already have a heightened risk of cardiovascular disease.
A research team at the University of Florida evaluated 154 patients with obesity and divided them into four groups: type 2 diabetes without NAFLD; type 2 diabetes with isolated steatosis (stage one of NAFLD); type 2 diabetes with non-alcoholic steatohepatitis (stage 2 of NAFLD); and a control group without type 2 diabetes or NAFLD.
The researchers found that the isolated steatosis and NASH groups had higher hepatic (in the liver) triglyceride levels compared to the other two groups – high triglyceride levels can increase the risk of heart attack and stroke. No differences in triglyceride levels were found between controls and those with diabetes but without NAFLD.
Those in the isolated steatosis or NASH groups had no significant association with poor blood pressure control, increased use of hypertensive medication or total or LDL cholesterol; but the NASH group had lower HDL and higher plasma triglycerides compared to type 2 or control patients.
Patients with type 2 diabetes (with or without NAFLD) had similar elevations in fasting plasma glucose levels and HbA1c compared to controls. Also, the isolated steatosis and NASH participants had increased fasting plasma insulin, which is known as hyperinsulinemia.
“In middle-aged obese patients with [type 2 diabetes], the presence of NAFLD is associated with hyperinsulinemia and more severe adipose tissue and hepatic insulin resistance, as well as worse atherogenic dyslipidemia,” the authors wrote.
“The clinical implication is that the presence of NAFLD in patients with [type 2 diabetes] should alert the health care provider to institute a more aggressive lifestyle intervention and consider strategies to minimize high cardiovascular risk.”
People with NAFLD are recommended to monitor their weight through eating a health diet and getting regular exercise. Furthermore, quitting smoking and avoiding alcohol can prevent NAFLD from becoming worse.
The findings appear in the online journal Diabetes Care.

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