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Diabetes and NAFLD – Fatty Liver Disease

It affects around a third of us — more if we are overweight or obese and have diabetes. Here’s what you need to know…

Non-alcoholic fatty liver disease (NAFLD) is a remarkably common condition — it affects up to one in three people in the UK (four out of five if we’re obese or overweight) — so it’s important to be aware of it. What do our livers do? The liver is our largest organ and performs hundreds of vital functions. It handles almost everything we eat, drink, inhale or inject, processes it for use by the body, or excretion into the urine or stools and stores iron, vitamins and glucose (sugar) as glycogen, for rapid conversion when we need instant energy. It metabolises/disposes of drugs, poisons and alcohol, manufactures proteins, including many needed for blood clotting and the immune system. It manufactures and controls cholesterol levels. It also produces yellow bile, containing digestive enzymes and unwanted chemicals/toxins; this is stored in the gall bladder and aids digestion, while waste products are excreted in the stool.

What causes NALFD?

In the commonest, early form, fat builds up in liver cells (steatosis); this can lead to inflammation (non-alcoholic steatohepatitis/ NASH — one in 20 adults and some children) and progress to scarring and fibrosis. One in 50 people with Non-Alooholic Fatty Liver Disease (NALFD) eventually develops cirrhosis — severe scarring that can lead to liver failure or cancer. You’re more likely to develop NAFLD if you are older, smoke, are overweight/apple-shaped, have type 2 diabetes, polycystic ovary syndrome and/or raised cholesterol or blood pressure levels, or viral hepatitis B/C infection.

It can also be triggered by excessive alcohol, rapid weight loss (dieting, or starvation/disease) and refeeding, genetic disorders, many drugs including oestrogens/tamoxifen and steroids and occasionally by pregnancy.

The symptoms

There are no symptoms in the early stages; the first sign may be a surprise blood-test result performed for other reasons. Later, liver inflammation can produce discomfort in the right upper tummy, weight loss, severe fatigue and weakness. With cirrhosis you may become itchy, jaundiced (yellow eyes/skin) with dark urine and pale stools, have swollen legs/tummy, bruise easily, bleed internally and become confused or even die.

Tests you may need

You’ll need a wide range of blood tests for other causes of liver damage including alcohol, drugs, infections, medicines, immune-system disorders, heart and lung conditions and cancer. A liver ultrasound scan may reveal NAFLD or fibrosis; a fibroscan and enhanced liver fibrosis (ELF) can check how severe they are. You may be referred to a liver specialist for a liver biopsy a sample taken using a local anaesthetic.

The treatment

In the early stages, lifestyle changes, particularly exercise and any necessary weight loss (see tips) may help to reduce fat inside liver cells.If you take statins, you should normally keep taking them. You may be offered vitamin E supplements or pioglitazone (a diabetes drug). You may also need a special diet, water pills or even a liver transplant for cirrhosis. Get advice and support from your Local Liver Trust helpline.

6 Ways to Help Your Liver

1. Maintain a healthy weight (even slim people may have internal fat). Aim for a body mass index (BMI) between 18.5 and 24.9 (calculate by inputting your height, weight into the BMI calculator) and a waist circumference of less than 80cm (women) or 94cm (men).

2. Eat a balanced diet with more fruit, veg and proteins, some starchy food (carbs) and less fat, sugar and salt. Only take vitamin/mineral supplements on your doctor’s advice.

3. Drink alcohol only within recommended limits — 14 units a week. Calculate units for various drinks

4. Exercise regularly — try to get pink and slightly puffed for at least 150 mins a week. Walk, run, cycle, swim, dance…

5. If you smoke, stop.

6 Check your personal risk of NAFLD using a health screener.

E297 – Fatty Liver Disease –
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