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Dear Dr. E,
My doctor told me I’ve had a fatty liver for at least a year, and on our last visit he said I have evidence of fibrosis, which really scared me. What does a fatty liver mean, and what do I need to do now?
First of all, I get it! No one likes being told they have a fat anything…unless it’s a bank account!
The clinical term for fatty liver disease was actually recently changed to MASLD, which honestly isn’t much better. It stands for “metabolic dysfunction–associated steatotic liver disease” (say that 10 times fast!), but all it means is that fat has developed in the liver due to metabolic issues like type 2 diabetes, obesity, and insulin resistance.
What Causes Fatty Liver Disease?
When you have insulin resistance, your liver starts making and storing more fat. The fat buildup in your liver causes inflammation, which can lead to fibrosis (scarring of the liver tissue) and a serious condition called MASH (metabolic dysfunction-associated steatohepatitis).
Fatty liver disease occurs on a continuum:
- MASLD (earlier stage): Fat builds up in the liver, leading to inflammation
- MASH (more advanced stage): Ongoing fat buildup in the liver with inflammation and the beginning of fibrosis
If left untreated, fibrosis progresses to cirrhosis, which is permanent liver scarring and late-stage liver disease. It requires a transplant in order to survive.
Fatty liver disease is the leading cause of liver transplants, so the goal is to catch and treat liver disease early, long before it gets anywhere near cirrhosis. The main issue is that fatty liver disease is asymptomatic until the late stages, when intervention is less effective.
What’s the Connection between Fatty Liver and Diabetes?
In the U.S., MASLD affects about 70% of people with type 2 diabetes. It’s so common in people with type 2 diabetes because many people with type 2 also have metabolic syndrome.
Metabolic syndrome is a cluster of conditions that includes high blood pressure, abnormal cholesterol, insulin resistance, and obesity. Obesity, insulin resistance, and inflammation are the main drivers of fatty liver disease.
How Is Fatty Liver Disease Diagnosed?
Many people don’t know they have liver disease for years because there aren’t fatty liver disease symptoms in the early stages. This is why everyone with diabetes who is overweight should be screened for liver disease annually.
Until recently, a MASLD diagnosis involved a liver biopsy. Nowadays we can start with blood tests that utilize a scoring system called the Fibrosis-4 (FIB-4) Index.
The FIB-4 Index combines routine lab values like SGOT, SGPT, and your age to determine if liver scarring is present. You also need a CBC for your platelet count. Some labs will calculate your FIB-4 automatically, and it will be on the lab results.
If the blood tests indicate there could be fibrosis, then a liver scan (typically an ultrasound, CT, or MRI) will be performed to help make a definitive diagnosis.
What’s the Treatment for Fatty Liver Disease?
Lifestyle modifications like weight loss, nutritional changes, and avoiding alcohol can make a big difference in the early stages, and for years those were the only treatments we had.
But now we have two medications to treat MASH – Rezdiffra and Wegovy. Redzdiffra was the very first medication approved by the FDA to target and treat MASH. It’s a once-daily pill that works directly in the liver to reactivate liver cells and help reduce liver fat.
Wegovy helps reduce liver fat, inflammation, and scarring through weight loss and improved metabolic function. Wegovy is the only GLP-1 approved for MASH, but Ozempic is the exact same drug, so it will have the same benefits. Mounjaro has shown positive results in clinical trials too, but their studies are still ongoing.
How Can You Prevent Fatty Liver Disease?
The same habits that help manage diabetes also help protect your liver:
- Maintaining a healthy weight
- Eating a balanced diet
- Staying physically active
- Managing blood sugar, cholesterol, and blood pressure
- If fibrosis is present, restricting alcohol (it’s hard for me to even write “restricting alcohol”, but when you have fibrosis, it really is important!)
Be sure to have regular checkups with your doctor and get screened annually for liver disease if you’re at risk.
MASLD and Diabetes: Key Takeaways
Here’s what I want you to keep in mind regarding fatty liver disease:
- Fatty liver disease is super common, and people with type 2 diabetes are twice as likely to have the condition as the rest of the population.
- Early detection is key. Most people don’t feel fatty liver symptoms until the condition is advanced. You need to screen and intervene!
- Lifestyle changes still matter for MASH and MASLD treatment, but we have two new therapies available now. Rezdiffra directly targets liver disease, and Wegovy leads to weight loss which will reduce fibrosis and improve fatty liver.
If you have diabetes and risk factors like obesity, high blood pressure, or abnormal cholesterol, talk to your doctor about being screened.
Your liver is one of the most important organs you have…don’t treat it like chopped liver!
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