Living with diabetes can increase the risk of various complications, including nonalcoholic fatty liver disease (NAFLD).

In this condition, excess fat builds up in the liver. Around 24% of people in the United States have NAFLD. But for adults who live with both obesity and type 2 diabetes, the estimates are greater than 70%.

This article will investigate the association between fatty liver disease and diabetes, whether one condition impacts the other, and how they can be managed effectively.

NAFLD is sometimes called fatty liver disease or hepatic steatosis. It’s defined as the buildup of excess fat in the liver. As its name implies, heavy alcohol use does not cause this form of liver disease.

NAFLD is becoming more common in Western countries, especially in the United States. NAFLD is one of the most common forms of liver disease in the country.

Up to two-thirds of people with type 2 diabetes have NAFLD, according to the National Institute of Diabetes and Digestive and Kidney Diseases. With type 1 diabetes on the rise nationally, the rate of NAFLD is also expected to increase. That’s tied to the growing T1D incidence and the related risk factors for the following:

  • obesity
  • high blood pressure
  • chronic hypertension, which is more common in people with diabetes

Some people who have NAFLD may develop nonalcoholic steatohepatitis (NASH). It’s an aggressive form of NAFLD marked by inflammation as well as fat buildup in the liver.

NASH may progress to liver scarring and damage (cirrhosis) and liver failure, which can be life threatening.

The main cause of NAFLD in people with diabetes is overweight or obesity. Weight loss is one way to slow the progression or reverse the development of NAFLD.

Studies show that losing just 7% to 10% of your body weight is the best way to achieve sustained weight loss. You can do this through regular physical exercise and calorie restriction.

High fructose consumption is also associated with the development of NAFLD. Limiting or avoiding high-sugar foods and drinks, like processed foods and sodas, can also be helpful in preventing or slowing the progression of NAFLD.

NAFLD is also common in people with high blood pressure and cholesterol. If you have NAFLD and it has progressed to NASH, some studies have linked taking statins to improved liver function and reduced cardiovascular events. Research notes that those statin-related benefits are specific to people without any liver issues after 3 years.

Oftentimes, NAFLD has no symptoms until it has progressed to advanced stages (cirrhosis or liver failure).

Symptoms of advanced liver disease include:

  • nausea
  • weight loss
  • loss of appetite
  • yellowing of the skin and whites of the eyes (jaundice)
  • swollen abdomen and legs
  • mental confusion
  • extreme fatigue
  • muscle weakness

If you’re experiencing any of these symptoms and have risk factors for NAFLD, contact your doctor for further testing.

Risk factors for NAFLD include:

  • high blood pressure
  • high cholesterol
  • overweight or obesity
  • type 2 diabetes

Having NAFLD may not affect your day-to-day at the beginning, but it can worsen over time. One contributing factor is having elevated blood glucose levels, like if you live with diabetes.

One 2021 study found that the average 3-month blood glucose levels of people with NAFLD determined their likelihood of having more severe cirrhosis, which can lead to liver failure.

A 2019 study found that NAFLD can lead to the overproduction of glucose, leading to insulin resistance and abnormal blood sugar levels. Over time, this can develop into prediabetes and type 2 diabetes.

In short, while NAFLD and diabetes don’t cause each other, they can exacerbate each other and make both conditions harder to manage.

There’s no particular diet for managing both diabetes and NAFLD. Rather, one goal is to lose and manage weight to help slow the progression of both conditions.

One way you can manage your weight is by eating a balanced, nutritious diet. Whole foods are one way to do this. Consider adding more of these foods to your diet:

  • fruits and vegetables
  • lean proteins like chicken, white fish, and turkey
  • lentils and legumes
  • whole grains
  • healthy fats, like extra-virgin olive oil, seeds, and nuts

If you smoke or drink alcohol, it’s important to quit. Quitting smoking and drinking can be difficult, but you don’t have to do it alone. Your doctor can help you create a quit plan that works for you and your needs.

Doctors also advise limiting or avoiding foods high in saturated fats and sugar, like:

  • cookies
  • cakes
  • ice creams
  • other desserts

There are no medications that can reverse NAFLD. But you can help slow its progression and, in some cases, reverse its damage with certain lifestyle strategies. These include:

  • managing your weight
  • eating a balanced, nutritious diet
  • increasing your physical activity
  • managing your blood sugar, blood pressure, and cholesterol levels

Most healthcare professionals recommend losing 3% to 5% of your body weight to see results in the liver. However, it’s important to lose weight sustainably. Rapid weight loss may actually make NAFLD worse, so aim to lose no more than 1 to 2 pounds per week.

Your doctor can help you plan the healthiest and most sustainable weight loss options for you.

One 2014 pilot study out of Japan suggests taking a glucagon-like peptide-1 (GLP-1) analog can help weight loss if you have diabetes and NAFLD.

Researchers in a 2013 study pointed out that taking thiazolidinediones, a drug for type 2 diabetes, may be beneficial for people who also have NAFLD. These medications help reduce insulin resistance and may lead to weight loss.

According to a 2014 study, dipeptidyl peptidase-4 (DPP-4) inhibitors may be beneficial if you have NAFLD and type 2 diabetes because they can lead to:

  • weight loss
  • reduced body mass index (BMI)
  • improved HbA1c levels

Taking these steps in the beginning stages of NAFLD can prevent permanent damage to your liver.

NAFLD affects up to two-thirds of people with type 2 diabetes. NAFLD often does not have any symptoms in its beginning stages but can lead to liver failure when not treated.

Higher blood sugars can also make NAFLD more difficult to treat, and having NAFLD can increase blood sugars.

The best treatment for NAFLD is weight loss. Eating a balanced diet and getting more exercise into your daily routine can help you manage your weight.

You may also want to talk with your doctor about taking certain medications, such as GLP-1 analogs, thiazolidinediones, or dipeptidyl peptidase-4 (DPP-4) inhibitors, to help you lose weight and improve insulin sensitivity.

When not treated, NAFLD can lead to nonalcoholic steatohepatitis (NASH), an aggressive form of NAFLD. It may also progress to cirrhosis and liver failure, which can be life threatening.