Dangers of Being 'Skinny Fat' with Diabetes

Diabetes and liver disease:

Implications of study are significant type 2 diabetes rates skyrockets in Singapore and elsewhere in Asia, where people have relatively low body weight.

Diabetes (Type 2 Diabetes Meillitus) is a disease often associated with obesity and a sedentary lifestyle.

A similar connection can be made between obesity and fatty liver disease (steatotic 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.

The Singapore Chinese Health Study

A study in Singapore has found an association between diabetes and risk of death from liver cirrhosis, or end-stage liver disease where liver dysfunction is evident, amongst Chinese people.

The study has also found that patients with diabetes who are lean may have a higher risk of death from cirrhosis caused by fatty liver disease as compared to heavier patients with diabetes.

This research, led by Professor Koh Woon Puay of Duke-NUS Medical School (Duke-NUS) and the Saw Swee Hock School of Public Health, National University of Singapore, and Dr George Goh, Senior Consultant, Department of Gastroenterology and Hepatology at Singapore General Hospital (SGH), was conducted using data from the Singapore Chinese Health Study, a prospective study that recruited about 63,000 middle-aged and elderly Chinese living in Singapore between 1993 and 1998.

"Obesity remains a risk-factor, but the effect of diabetes in lean patients in relation to fatty liver cirrhosis mortality is paradoxically higher than that in overweight patients. The underlying reason for a higher risk of fatty liver disease related death among lean patients with diabetes has not been ascertained. Nonetheless, it is important that patients with diabetes be actively screened for liver disease, in addition to other known complications," said Dr George Goh.

Lower weight yet higher risk

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.

The 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.

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.

The importance of liver screening

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 liver 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

Related articles:
Fatty Liver: Causes and How to Reverse It

Visceral Fat (Belly Fat) and Diabetes: What's the Link?

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