Insulin resistance and nonalcoholic fatty liver disease (NAFLD) often coexist. Obesity and metabolic syndrome are shared risk factors. Insulin resistance may also promote storage of fat in your liver.

Insulin resistance is when your cells stop responding as they should to insulin, and your pancreas compensates by producing more insulin. It can lead to chronically high blood sugar levels and prediabetes or type 2 diabetes.

NAFLD is the buildup of fat in your liver. It’s not associated with high alcohol consumption. It’s very common in people with overweight or obesity. If NAFLD causes inflammation and damage to your liver, it’s called nonalcoholic steatohepatitis (NASH).

Insulin resistance and NAFLD share risk factors, and insulin resistance may promote the storage of fat in your liver. Read on to learn more about the connection between these two common conditions.

Was this helpful?

Insulin resistance is a feature of type 2 diabetes. People with type 2 diabetes have a high risk of developing NAFLD. NAFLD and insulin resistance share risk factors, and insulin resistance may play a role in the development of NAFLD.

Metabolic syndrome and obesity are both associated with a high risk of developing NAFLD and insulin resistance.

Metabolic syndrome is a group of conditions that raise your risk of health conditions such as stroke, coronary artery disease, and diabetes. More than 40% of U.S. adults are thought to meet the diagnostic criteria for metabolic syndrome.

The defining features of metabolic syndrome are:

Along with sharing risk factors, insulin resistance may increase the storage of fat in your liver by promoting lipolysis, which is the breakdown of fat for energy.

Increased lipolysis can lead to chronically elevated fat levels in your blood. Doctors refer to this increased fat in your blood as high triglycerides.

NAFLD can develop when your body stores some of this excess fat from your blood in your liver.

How common is type 2 diabetes in people with NAFLD?

According to a 2024 research article, it’s thought that NAFLD occurs in around 60% to 86% of people with type 2 diabetes.

The presence of type 2 diabetes in people with NAFLD is also associated with faster progression to cirrhosis (liver scarring). About half of people with type 2 diabetes have NASH, and about 1 in 6 have advanced cirrhosis.

In reverse, people with NAFLD have about twice the risk of developing type 2 diabetes as people without NAFLD, notes the 2024 research article.

Was this helpful?

The main cause of insulin resistance is thought to be too much visceral fat, or fat around your organs in your abdomen.

Insulin resistance is strongly linked to a waist circumference over 40 inches (102 centimeters) in men and over 35 inches (89 centimeters) in women, notes the National Institute of Diabetes and Digestive and Kidney Diseases.

Increased visceral fat is highly associated with physical inactivity and excess overall body weight.

NAFLD involves increased fat storage in the liver of a person who doesn’t consume large amounts of alcohol. It’s highly associated with:

Excess fat storage in the liver associated with high alcohol consumption is called alcoholic fatty liver disease (AFLD).

What are the symptoms of NAFLD?

NAFLD usually doesn’t cause noticeable symptoms. It might not even cause symptoms if it progresses to NASH.

If symptoms do appear, they might include tiredness or pain in the upper right of your abdomen.

Was this helpful?

NAFLD can lead to NASH and serious liver scarring called cirrhosis. Cirrhosis can lead to liver failure and many complications, such as:

Insulin resistance is a feature of type 2 diabetes. Type 2 diabetes can cause complications such as:

  • heart disease and stroke
  • blindness
  • kidney disease
  • nerve damage
  • poor circulation requiring amputation

Insulin resistance and type 2 diabetes treatments may include:

Learn more about treatment for insulin resistance.

NAFLD treatments may include:

  • lifestyle changes, such as:
    • losing weight
    • eating an overall balanced diet
    • increasing physical activity
    • avoiding alcohol
    • limiting medications that can damage your liver
  • medications to:
    • lower cholesterol and triglycerides
    • lower blood pressure
    • manage diabetes

You can potentially reverse NAFLD with lifestyle changes. Many people never develop serious complications from NAFLD. However, if it progresses to NASH, it can lead to severe liver damage that may impair your quality of life or life span.

Lifestyle changes can also help manage insulin resistance and type 2 diabetes, as well as taking medications in some cases. If diabetes isn’t properly managed, it may lead to complications that severely reduce your quality of life and life span.

NAFLD is highly associated with insulin resistance. The two conditions share some risk factors, like obesity and metabolic syndrome. Insulin resistance may also promote the storage of fat in your liver.

Lifestyle changes, like losing weight if you have overweight or obesity, can often treat both conditions. Your doctor may also recommend taking medications to help manage one or both conditions.