People with type 2 diabetes are more likely to develop complications from nonalcoholic fatty liver disease (NAFLD).

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Eating a healthy diet like the Mediterranean diet can help cut down on complications from liver disease. Getty Images

The obesity epidemic has led to a ripple effect for the health of Americans, increasing their risk of many other health problems.

One of these is nonalcoholic fatty liver disease (NAFLD), a chronic condition that affects between 30 and 40 percent of American adults. This condition can lead to scarring or cancer in the liver, and in some cases liver failure.

Researchers are now learning how NAFLD is strongly linked to obesity, type 2 diabetes, high blood pressure, and abnormal blood lipid levels.

Among the new findings, people with type 2 diabetes are most at risk of developing serious liver complications if they have NAFLD.

With obesity and diabetes rates increasing in the United States, experts say there is a need for better NAFLD treatments, a focus on prevention and greater awareness of this condition among primary care doctors.

There are two types of NAFLD, which causes a buildup of excess fat in the liver. But in this case the fat in the liver is not related to heavy alcohol use.

The majority of people have simple fatty liver, in which there is excess fat in the liver, but little or no liver cell damage or inflammation.

About 20 percent of people with NAFLD have a second type called nonalcoholic steatohepatitis (NASH). This involves inflammation in the liver — hepatitis — and liver cell damage.

NASH can lead to scarring of the liver (cirrhosis) or liver cancer.

Dr. Maya Balakrishnan, an assistant professor of medicine and gastroenterology at Baylor College of Medicine in Houston, Texas, said several “red flags” indicate that someone with NAFLD may have the more serious type, or NASH — diabetes, older age, high blood pressure, metabolic syndrome, and an elevated liver enzyme test.

However, doctors need to use blood tests, medical imaging tests, and sometimes a liver biopsy to make a definite diagnosis of NAFLD or NASH.

Healthy eating and exercise have the best chance of preventing liver disease if you start early.

Unfortunately, a recent study published this month suggests that many people are diagnosed at a later stage of NAFLD or NASH.

This study, published in BMC Medicine, also found that fewer people than expected were being diagnosed with NAFLD or NASH at primary care centers.

The BMC Medicine study authors found that people with type 2 diabetes had the highest risk of developing liver complications from NASH such as cirrhosis or cancer.

The authors write that greater awareness of NAFLD among primary care physicians could lead to earlier detection of the condition, when treatments can be more effective.

“Nonalcoholic fatty liver disease is the most common cause of chronic liver disease,” said Dr. Hugo Rosen, professor and chair of the department of medicine at the Keck School of Medicine of USC in Los Angeles. “Clearly, there needs to be increased awareness of NAFLD among primary care doctors.”

Balakrishnan said this is a good reminder that diabetes is a major risk factor for many adverse health problems, not just liver disease, but also kidney disease, stroke and foot complications.

Eating healthier and exercising regularly can reduce your risk of all of these.

In addition to diabetes, overall obesity is a huge risk factor for this liver condition.

Some research has found that more than 90 percent of people with severe obesity who were undergoing bariatric surgery had NAFLD.

“Obesity is the most common and well-documented risk factor for NAFLD,” Rosen, said.

No medications have been approved to treat NAFLD or NASH, but lifestyle changes can reduce your risk of developing liver complications.

“We counsel all patients that weight loss is the best — and really the only — widely available treatment for the disease,” said Balakrishnan.

She said research suggests that someone with NAFLD needs to lose at least 5 percent of their original body weight to see a reduction of fat in the liver.

For a 200-pound person, this means losing 10 pounds.

If a person has NASH, or their doctor suspects they may have this condition, Balakrishnan said they should aim for 7 to 10 percent weight loss.

This greater weight loss is needed to reduce the scar tissue and inflammation in the liver that occurs in NASH.

Rosen said that weight loss surgery — bariatric surgery — has been shown to greatly improve NAFLD and NASH, as well as reduce a person’s risk of dying from cardiovascular disease.

Non-surgical weight loss through dietary changes and exercise can also be effective — if you can keep the weight off.

Many healthy diets can help you lose weight, but some may have extra benefits for the liver.

“Research shows that following a Mediterranean diet is probably the healthiest choice for both promoting weight loss and promoting liver health,” said Balakrishnan.

There are many version of the Mediterranean diet, but in general it involves eating mainly fruits, vegetables, nuts, seeds, whole grains, fish, seafood and olive oil.

Rosen said all patients with NAFLD should also add regular exercise — aerobic or resistance training — to their daily routine, since this has been shown to have liver benefits beyond just helping you lose weight.

Cutting back on alcohol intake may also help the liver. Rosen pointed to a recent study that found even moderate alcohol consumption was associated with a worsening of fibrosis, or scarring, of the liver.