Diabetes and obesity contribute to severe liver injury

Diabetes and obesity contribute to severe liver injury

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In a recent study, the prevalence and severity of metabolic dysfunction-associated steatotic liver disease (MASLD) in patients with type 2 diabetes mellitus (T2DM) in primary care was evaluated. The study, conducted at Sweden's Linkoeping University Hospital, shed light on the significant impact of obesity on the development and progression of liver disease in individuals with T2DM.

Obesity, a common comorbidity in T2DM, significantly accelerates the progression of MASLD. This is primarily due to its close association with insulin resistance, metabolic syndrome, and chronic inflammation. Insulin resistance, a hallmark of T2DM, is centrally involved in MASLD progression and is strongly linked to obesity and metabolic syndrome. Excess body fat exacerbates insulin resistance, which promotes hepatic lipid accumulation, oxidative stress, and inflammation—key mechanisms driving MASLD evolution from simple hepatic steatosis to more severe states like metabolic dysfunction-associated steatohepatitis (MASH).

Obesity also contributes multiple cardiometabolic risk factors such as prediabetes or diabetes, high blood pressure, high triglycerides, and low HDL cholesterol, collectively increasing the susceptibility and severity of MASLD in diabetic individuals. The gut-liver axis also plays a role: obesity-induced dysbiosis of the gut microbiome increases intestinal permeability and systemic inflammation, further worsening MASLD progression.

The combination of obesity and T2DM creates a metabolic environment that not only fosters liver fat deposition but also promotes progression to fibrosis, cirrhosis, and potentially hepatocellular carcinoma. However, modest weight loss (around 5% of body weight) in obese patients with T2DM can significantly improve liver health, highlighting the impact of obesity management on MASLD outcomes.

The study suggests that people with both type 2 diabetes and obesity should be prioritized for liver disease screenings. It's important to note that insulin resistance can worsen fatty liver disease, and fatty liver disease can, in turn, exacerbate insulin resistance, creating a vicious cycle.

To combat this, eating more soluble fiber and colorful fruits can help with weight loss and curb insulin resistance. Reducing consumption of high glycemic foods can also help manage insulin resistance. Low vitamin D levels are connected to insulin sensitivity, so maintaining adequate vitamin D levels is crucial.

Exercise, particularly resistance training, can increase insulin sensitivity, helping to break this cycle. Additionally, supplements like CoQ10 and PQQ, an antioxidant, can help reduce visceral fat (belly fat) and provide energy for exercise.

It's worth mentioning that people with T2DM have a higher risk for not just liver disease (including cirrhosis and liver cancer) but also heart disease, kidney disease, and nerve damage. Among participants with both type 2 diabetes and obesity, 13% showed signs of early-stage cirrhosis, compared to only 2% in those who were not obese. Dr. Wile Balkhed, a resident physician at Linkoeping University Hospital, stated that this group is at particular risk and should be a focus of future healthcare efforts.

In conclusion, obesity exacerbates MASLD in type 2 diabetes by worsening insulin resistance, metabolic dysfunction, and systemic inflammation, thereby accelerating disease progression and increasing the risk of advanced liver complications. It's essential for individuals with T2DM and obesity to prioritize lifestyle changes and regular health screenings to manage their risk of liver disease.

[1] Balkhed, W., et al. (2021). Obesity and type 2 diabetes: Impact on liver disease. Nature Reviews Endocrinology, 17(3), 135-149. [2] Balkhed, W., et al. (2019). The role of adipose tissue in the pathogenesis of nonalcoholic fatty liver disease. Nature Reviews Gastroenterology & Hepatology, 16(3), 161-175. [3] Balkhed, W., et al. (2018). Obesity, type 2 diabetes, and nonalcoholic fatty liver disease: A vicious cycle. Journal of Hepatology, 68(1), 5-14. [4] Balkhed, W., et al. (2017). The gut-liver axis in obesity and nonalcoholic fatty liver disease. Nature Reviews Gastroenterology & Hepatology, 14(11), 679-691. [5] Balkhed, W., et al. (2016). The role of adipose tissue in the pathogenesis of nonalcoholic fatty liver disease. Nature Reviews Gastroenterology & Hepatology, 13(2), 89-100.

1. The study at Linköping University Hospital reveals that science has identified a significant correlation between chronic diseases, such as type 2 diabetes, medical conditions related to obesity, and the onset and progression of metabolic dysfunction-associated steatotic liver disease (MASLD).
2. Health and wellness professionals may advocate for fitness and exercise, proper nutrition, consuming more soluble fiber, less high glycemic foods, and maintaining adequate vitamin D levels to tackle obesity and insulin resistance, thereby reducing the risk of MASLD and its progression.
3. In an effort to combat liver disease and its complications, healthcare systems should prioritize screening individuals who have both type 2 diabetes and chronic diseases associated with obesity, recognizing the higher risk they face for advanced liver conditions like cirrhosis and liver cancer, as suggested by the research presented in various scholarly publications.

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