Diabetes is a disease often associated with obesity and a sedentary lifestyle. A similar connection can be made between obesity and fatty liver disease – damage to the liver from build-up of fatty tissue in the liver when the body is unable to handle excess dietary fat. 

betes and liver disease connection
Not surprisingly, evidence from research is showing a relation between diabetes and liver disease. But a new study has found greater weight and the risk of dying from liver disease to have less of a connection for people with diabetes.

The Association Between Diabetes Mellitus And Cirrhosis Mortality: The Singapore Chinese Health Study found that among participants with diabetes, those with normal or below-normal BMI (body mass index) had a greater chance of dying from fatty liver disease than those who were overweight. 

WEIGHT low, RISK higher
It noted that among participants who did not have diabetes, the risk of death from fatty liver disease was 1.72 times higher among the overweight when compared to lean participants. That risk increased threefold for patients who were both diabetic and overweight. However, the risk was highest – at 5.5 times – among those who were diabetic, but lean.

The study was led by Professor Koh Woon Puay of Duke-NUS Medical School and the Saw Swee Hock School of Public Health, National University of Singapore, and Dr George Goh, Consultant, Department of Gastroenterology and Hepatology, Singapore General Hospital (SGH).

The research looked at data from the Singapore Chinese Health Study – a previous study by Prof Koh that had recruited some 63,000 middle-aged and elderly Chinese living in Singapore between 1993 and 1998. Information on each participant’s diet, lifestyle, and medical history had been recorded via in-person interviews. Participants in the cohort who later died from liver cirrhosis were identified via the nationwide death registry for the new study. Over an average of 17 years of follow-up, up to the end of 2014, the number of deaths from cirrhosis in the cohort stood at 133.

Although the findings clarified the relationship between diabetes and cirrhosis-related deaths, Dr Goh said that “the underlying reason for a higher risk of fatty liver disease-related death among lean patients with diabetes has not been ascertained”.

Still, the findings have important implications, with the incidence of type 2 diabetes – which is linked to obesity and a sedentary lifestyle – increasing at an alarming rate in Singapore and elsewhere in Asia, where people have relatively low body weights.

For this reason, patients with diabetes should be screened for liver disease in addition to other known complications, said Dr Goh. “This may be even more [important] in lean diabetic patients as the risk is paradoxically highest in this group,” he added.

Liver disease, like cirrhosis, or hardening and scarring of the organ, usually has no signs or symptoms until it is advanced – when treatment options get limited. And liver ailments are usually not included in the bundle of screening tests for diabetes management.
In Asian populations, chronic hepatitis B or C infection is the main risk factor for severe liver disease. But the number of cirrhosis deaths from viral causes is expected to decline because of vaccination against hepatitis B infection and effective treatment for viral hepatitis B and C. 

On the other hand, fatty liver disease is increasing in both Western and Asian populations as an important cause of chronic liver disease and consequently cirrhosis death.

Ref: N18