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Do Diabetics Have Fatty Liver?

Liver Disease And Diabetes Mellitus

Liver Disease And Diabetes Mellitus

CLINICAL DIABETES VOL. 17 NO. 2 1999 These pages are best viewed with Netscape version 3.0 or higher or Internet Explorer version 3.0 or higher. When viewed with other browsers, some characters or attributes may not be rendered correctly. FEATURE ARTICLE Gavin N. Levinthal, MD, and Anthony S. Tavill, MD, FRCP, FACP IN BRIEF Liver disease may cause or contribute to, be coincident with, or occur as a result of diabetes mellitus. This article addresses these associations. This article addresses the role of the liver in normal glucose homeostasis and discusses a variety of liver conditions associated with abnormal glucose homeostasis. This association may explain the pathogenesis of the liver disease or of the abnormal glucose homeostasis, or may be purely coincidental (Table 1). Table 1. Liver Disease and Diabetes Mellitus 1. Liver disease occurring as a consequence of diabetes mellitus Glycogen deposition Steatosis and nonalcoholic steatohepatitis (NASH) Fibrosis and cirrhosis Biliary disease, cholelithiasis, cholecystitis Complications of therapy of diabetes (cholestatic and necroinflammatory) 2 . Diabetes mellitus and abnormalities of glucose homeostasis occurring as a complication of liver disease Hepatitis Cirrhosis Hepatocellular carcinoma Fulminant hepatic failure Postorthotopic liver transplantation 3 . Liver disease occurring coincidentally with diabetes mellitus and abnormalities of glucose homeostasis Hemochromatosis Glycogen storage diseases Autoimmunebiliary disease The prevalence of type 1 diabetes in the United States is ~0.26%. The prevalence of type 2 diabetes is far higher, ~1–2% in Caucasian Americans and up to 40% in Pima Indians. According to the Centers for Disease Control and Prevention, hepatitis C alone chronically infects more than 1.8% of the A Continue reading >>

Type 2 Diabetes And Fatty Liver Disease

Type 2 Diabetes And Fatty Liver Disease

Non-alcoholic fatty liver disease is a group of conditions in which fat builds up in the liver, leading to inflammation of the cells where it is stored and causing the liver to get bigger. It can progress to more serious conditions, including fibrosis and cirrhosis of the liver. Fatty liver disease "is so common. It’s present arguably in a majority of type 2 diabetics,” says Daniel Einhorn, MD, clinical professor of medicine at the University of California, San Diego and the medical director of the Scripps Whittier Diabetes Institute. “None of us thought about it more than about 10 years ago, then all of a sudden we discovered it and see it all the time.” Fatty Liver Disease and Type 2 Diabetes: The Connection Diabetes does not cause fatty liver disease. Instead, the two diseases tend to occur in the same people because the same conditions cause both problems. “So, it’s not the diabetes per se. People with diabetes also have obesity and insulin resistance, and so the fatty liver is thought to be part of that,” Dr. Einhorn explains. Einhorn says that most cases of fatty liver disease do not cause any harm. However, since type 2 diabetes and obesity are so common in the United States, fatty liver disease is now a leading cause of end-stage (fatal) liver disease requiring a liver transplant, along with alcohol abuse and hepatitis. Fatty Liver Disease Diagnosis Fatty liver disease has no symptoms. People who are being treated for diabetes will have liver enzyme tests as part of their routine blood work during medical exams. Ninety-nine percent of the cases of fatty liver disease are detected by this test, says Einhorn. In some cases it will be picked up during the physical exam or in imaging studies, like a computed tomography scan of the abdomen or a liver ul Continue reading >>

Fatty Liver And Type 2 Diabetes

Fatty Liver And Type 2 Diabetes

This article was featured in the May 2012 issue ofDiabetes Forecast Magazine, a publication of the American DiabetesAssociation. Nonalcoholic fatty liverdiseaseNAFLD, for shortis the most common chronic liver disease in America. Because of the livers central role in so many body processes, fat in the liver can have a ripple effect, increasing the risks of developing both cardiovascular disease and type2 diabetes . The links between NAFLD and type2 are particularly well documented. Eighty percent of people with diabetes have fat in the liver, says Kenneth Cusi , MD, FACP, FACE, an endocrinologist at the University of Florida in Gainesville. Increasingly, researchers are realizing that the connection is no coincidence. When I was in medical school, people thought obesity-related fat in the liver was an innocent bystander, Cusi says. Now endocrinologists are starting to realize this is a problem that hits home. Research indicates that NAFLD may contribute to prediabetes and type2 diabetes. Because the liver plays such an important role in regulating the bodys blood sugar, the buildup of fat in the vital organ makes it harder to control fasting glucose levels. It also makes the body more resistant to insulin, straining the pancreas and its beta cells and speeding up the arrival of type2 diabetes. When you get fatty liver, diabetes is harder to control, Cusi says. Yet even though the majority of people with type2 diabetes may have fatty livers, Cusi says the condition is typically undiagnosed, because of a lack of awareness among some doctors and the hidden nature of the disease. So who gets fatty liver, and why? Studies have shown that Latinos are more likely to have type2 diabetes than most other ethnic or racial groups, a finding that made Cusi wonder if there was a link Continue reading >>

Diabetes: How Do I Help Protect My Liver?

Diabetes: How Do I Help Protect My Liver?

If I have diabetes, is there anything special I need to do to take care of my liver? Answers from M. Regina Castro, M.D. You're wise to wonder about steps to protect your liver. Diabetes raises your risk of nonalcoholic fatty liver disease, a condition in which excess fat builds up in your liver even if you drink little or no alcohol. This condition occurs in at least half of those with type 2 diabetes. It isn't clear whether the condition appears more often in people with type 1 diabetes than in the general population because obesity, which is a risk factor, occurs with similar frequency in both groups. Other medical conditions, such as high cholesterol and high blood pressure, also raise your risk of nonalcoholic fatty liver disease. Fatty liver disease itself usually causes no symptoms. But it raises your risk of developing liver inflammation or scarring (cirrhosis). It's also linked to an increased risk of liver cancer, heart disease and kidney disease. Fatty liver disease may even play a role in the development of type 2 diabetes. Once you have both conditions, poorly managed type 2 diabetes can make fatty liver disease worse. Your best defense against fatty liver disease includes these strategies: Work with your health care team to achieve good control of your blood sugar. Lose weight if you need to, and try to maintain a healthy weight. Take steps to reduce high blood pressure. Keep your low-density lipoprotein (LDL, or "bad") cholesterol and triglycerides — a type of blood fat — within recommended limits. Don't drink too much alcohol. If you have diabetes, your doctor may recommend an ultrasound examination of your liver when you're first diagnosed and regular follow-up blood tests to monitor your liver function. Continue reading >>

Diabetes And Nonalcoholic Fatty Liver Disease: A Pathogenic Duo

Diabetes And Nonalcoholic Fatty Liver Disease: A Pathogenic Duo

Limitation of Use: The safety and efficacy of Humulin R U-500 used in combination with other insulins has not been determined. The safety and efficacy of Humulin R U-500 delivered by continuous subcutaneous infusion has not been determined. For the Humulin R U-500 vial, particular attention should be paid to the 20-mL vial size, prominent “U-500” and warning statements on the vial label, and distinctive coloring on the vial and carton. Dosing errors have occurred when Humulin R U-500 was administered with syringes other than a U-500 insulin syringe. Patients should be prescribed U-500 syringes for use with Humulin R U-500 vials. The dose of Humulin R U-500 should always be expressed in units of insulin. DO NOT transfer Humulin R U-500 from the Humulin R U-500 KwikPen into any syringe for administration. Overdose and severe hypoglycemia can occur. Hyperglycemia or Hypoglycemia with Changes in Insulin Regimen: Changes in insulin, manufacturer, type, or method of administration should be made cautiously and only under medical supervision and the frequency of blood glucose monitoring should be increased. Hypoglycemia: Hypoglycemia is the most common adverse reaction associated with insulin, including Humulin R U-500. Severe hypoglycemia can cause seizures, may be life-threatening, or cause death. Severe hypoglycemia may develop as long as 18 to 24 hours after an injection of Humulin R U-500. Hypoglycemia can impair concentration ability and reaction time; this may place an individual and others at risk in situations where these abilities are important, such as driving or operating other machinery. Early warning symptoms of hypoglycemia may be less pronounced in patients with longstanding diabetes, in patients with diabetic nerve disease, in patients using medications th Continue reading >>

Vitamin D And Fatty Liver In Diabetes

Vitamin D And Fatty Liver In Diabetes

Reviewed by Clifton Jackness, MD, Assistant Professor, Hofstra Northwell School of Medicine, New York, NY As many as 9 of 10 patients with obesity and type 2 diabetes have non-alcoholic fatty liver disease (NAFLD), and 20% of the general public has the same problem, making it the most common liver disease in the world. 1 Diabetes can also hasten the progression of the disorder to more serious hepatic conditions like cirrhosis and liver cancer. Although there is no well-documented treatment protocol for NAFLD, there is evidence to suggest that vitamin D deficiency may play a role in its development. For example, hypovitaminosis D has been correlated with the histological changes of NAFLD. A meta-analysis has also found that patients with NAFLD are more likely than control subjects to have a vitamin D deficit. This evidence is also consistent with certain biochemical findings: The vitamin is known to play a role in hepatic metabolism through the VDR receptor, according to Ilaria Barchetta and associates at the Sapienza University of Rome. Finally, vitamin D appears to increase insulin sensitivity by means of free fatty acid flux modulation. Hypovitaminosis D has been correlated with the histological changes of non-alcoholic fatty liver disease. A randomized, double-blind, placebo-controlled study using 2,000 IU a day of oral cholecalciferol found the nutrient/hormone did not improve hepatic function in diabetics with fatty liver. The fact that the RCT included only 65 patients may have produced false negative results because the sample size was too small to detect a true therapeutic effect. These lines of evidence suggest that vitamin D may be valuable as a therapeutic agent for patients with diabetes and fatty liver. To explore that possibility, Barchetta et al recruited Continue reading >>

Half Of Patients With Type 2 Diabetes Have Nonalcoholic Fatty Liver Disease

Half Of Patients With Type 2 Diabetes Have Nonalcoholic Fatty Liver Disease

Half of Patients With Type 2 Diabetes Have Nonalcoholic Fatty Liver Disease Commentary by Paola Portillo-Sanchez, MD, and Discussion by Giovanni Targher, MD Nonalcoholic fatty liver disease (NAFLD) was found in 50% of patients with type 2 diabetes who had normal aminotransferase levels in a recent study reported in the June issue of the Journal of Clinical Endocrinology & Metabolism. We found that in patients with type 2 diabetes mellitus, who were screened by the non-invasive gold-standard of liver magnetic resonance spectroscopy (1H-MRS), there was a surprisingly high prevalence of NAFLD (36% and 56% in overweight and obese, respectively), even in the absence of plasma AST/ALT elevations, said lead author Paola Portillo-Sanchez, MD, Post Doctoral Associate, Division of Endocrinology, Diabetes, and Metabolism at the University of Florida. Moreover, more than half of these patients (56%) had developed the more severe form of liver disease called nonalcoholic steatohepatitis (NASH), Dr. Portillo-Sanchez said. From these findings, the most important clinical implication for practitioners is that NAFLD and NASH occur frequently in patients with T2DM, regardless of aminotransferase levels, and therefore, AST and ALT should be interpreted with caution when screening or following these patients, Dr. Portillo-Sanchez said. The study involved 103 patients with type 2 diabetes and normal plasma aminotransferase levels, and without a prior diagnosis of NAFLD. The majority of patients (70%) were obese (BMI 30 kg/m2). The prevalence of NAFLD was 56% in patients with obesity and 36% in patients without obesity. Increasing body mass index was significantly associated with a greater prevalence of NAFLD (P=0.001). In addition, a higher plasma hemoglobin A1C was significantly associate Continue reading >>

Non-alcoholic Fatty Liver Disease

Non-alcoholic Fatty Liver Disease

Non-alcoholic fatty liver disease (NAFLD) is the generic term used to describe conditions that cause fat to build up within the liver. It is a common disease that often occurs in people who are overweight or obese, including those with type 2 diabetes. How serious is non-alcoholic fatty liver disease? For most people, having small amounts of fat in the liver cells usually causes no problems. But for others, the build-up of liver fat can lead to serious health problems. NAFLD, in particular, increases the risk of cardiovascular issues such as heart attack and stroke, which makes it particularly dangerous for people with type 2 diabetes who already have a greater risk of cardiovascular disease. I have diabetes, how do I avoid non-alcoholic fatty liver disease? Lowering the risk of non-alcoholic fatty liver disease is generally a matter of gradual weight loss and maintaining regular exercise. This also helps to lower the risk of cardiovascular problems. What is the function of the liver? The liver helps to store fuel (glycogen) made from sugars, breaking it down and releasing it to the bloodstream. Fats and proteins are processed and toxins are removed by the liver. Bile, which breaks down the fat in foods, is also created by the liver. What are the stages of NAFLD? Non-alcoholic fatty liver disease (NAFLD) can be broken down into four different stages: Stage 1: Steatosis (simple fatty liver) Steatosis is where there is excess fat in the liver but not to an extent to cause symptoms to appear. As a result, fatty liver disease is often not picked up until a later stage. Stage 2: Non-alcoholic steatohepatitis (NASH) Steatohepatitis (NASH) occurs if the liver becomes damaged causing it to become inflamed. Symptoms such as a pain in the top right of your abdomen may be felt at Continue reading >>

Spectrum Of Liver Disease In Type 2 Diabetes And Management Of Patients With Diabetes And Liver Disease

Spectrum Of Liver Disease In Type 2 Diabetes And Management Of Patients With Diabetes And Liver Disease

It is estimated that 20.8 million people, i.e., 7.0% of the U.S. population, have diabetes (1). Type 2 diabetes, with its core defects of insulin resistance and relative insulin deficiency, accounts for 90–95% of those with the disease. Another 5.2 million people are estimated to have undiagnosed type 2 diabetes. It is the sixth leading cause of death (1) in the U.S. and accounts for 17.2% of all deaths for those aged >25 years (2). Liver disease is an important cause of death in type 2 diabetes. In the population-based Verona Diabetes Study (3), cirrhosis was the fourth leading cause of death and accounted for 4.4% of diabetes-related deaths. The standardized mortality ratio (SMR), i.e., the relative rate of an event compared with the background rate, for cirrhosis was 2.52 compared with 1.34 for cardiovascular disease (CVD). In another prospective cohort study (4), cirrhosis accounted for 12.5% of deaths in patients with diabetes. Diabetes, by most estimates, is now the most common cause of liver disease in the U.S. Cryptogenic cirrhosis, of which diabetes is, by far, the most common cause, has become the third leading indication for liver transplantation in the U.S. (5,6). Virtually the entire spectrum of liver disease is seen in patients with type 2 diabetes. This includes abnormal liver enzymes, nonalcoholic fatty liver disease (NAFLD), cirrhosis, hepatocellular carcinoma, and acute liver failure. In addition, there is an unexplained association of diabetes with hepatitis C. Finally, the prevalence of diabetes in cirrhosis is 12.3–57% (7). Thus, patients with diabetes have a high prevalence of liver disease and patients with liver disease have a high prevalence of diabetes. The management of diabetes in patients with liver disease is theoretically complicated b Continue reading >>

Preventing Fatty Liver Disease (nafld)

Preventing Fatty Liver Disease (nafld)

When was the last time you had a chat with your doctor about your liver? Can’t remember? Maybe never? Well, it’s probably time to do so. Most people who have diabetes think very little about the connection between liver disease and Type 2 diabetes. But statistics show that at least 50% of those with Type 2 will develop fatty liver disease, and some research shows that figure may even be as high as 70%. What is fatty liver disease? To be more exact, fatty liver disease is technically called “non-alcoholic fatty liver disease,” or NAFLD, for short. As the name implies, it’s characterized by a buildup of fat in the liver that’s unrelated to drinking alcohol. The extent of fat buildup can determine the extent of liver damage, ranging from a small accumulation of fat (called steatosis) to a large amount that causes inflammation (called steatohepatitis). Without treatment, NAFLD can progress to cirrhosis (chronic scarring and damage), liver failure, and possibly liver cancer. What causes NAFLD? NAFLD is becoming increasingly common; in fact, it’s the most common type of liver disease in the developed world. It’s also a very complex condition. There’s no one specific cause, but it appears that this disease is linked to: • Being overweight or obese • Having insulin resistance (a condition whereby the body doesn’t use its own insulin properly) • Having high blood sugar levels (prediabetes or Type 2 diabetes) • Having high levels of fat, called triglycerides, in the blood • Having sleep apnea • Having PCOS (polycystic ovary syndrome) In addition, NAFLD is more common in older people, men, people who have Type 2 diabetes, and people who have excess weight around their middle (like a “spare tire” or a “muffin top”). What happens in NAFLD? The Continue reading >>

Why You Should Know About Fatty Liver Disease

Why You Should Know About Fatty Liver Disease

Non-alcoholic fatty liver disease can be a problem for people with diabetes, especially type 2 diabetes. Learn more about this growing condition. Fatty liver disease is an “underappreciated problem that seems to be getting worse,” according to Mitch Lazar, MD, PhD, chief of the division of endocrinology, diabetes and metabolism at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia. For many years physicians believed that fatty liver was a benign condition but in 1980 non-alcoholic fatty liver disease (NAFLD) was designated a real condition. “Fortunately with increasing knowledge and research on the disease, there is a growing awareness,” says Dina Halegoua-Demarzio, MD, director of the Fatty Liver Center at Thomas Jefferson University Hospital, also located in Philadelphia. “More awareness of the problem in doctors and patients will enable early intervention that can prevent cirrhosis, liver failure and liver cancer.” It’s a particular issue for people with type 2 diabetes. Up to 70 percent of obese type 2 diabetes patients have fatty livers, meaning at least five percent of liver cells show evidence of fat. Although fatty livers are benign and estimates vary considerably, about five to 10 percent of people with the condition will go on to develop the more serious non-alcoholic steatohepatitis (NASH) that causes inflammation, scarring and damage to the liver cells. 1 Fatty livers can also start a cascade of serious damage to the liver and attempts by the organ to regenerate itself that culminate in an abundance of scar tissue and impaired liver function. It has also been linked to increased risk of heart attack and stroke.2 Studies show that anywhere from three to 26 percent of people with NASH will progress to cirrhosis, whi Continue reading >>

Fatty Liver May Be Linked To Diabetes Risk

Fatty Liver May Be Linked To Diabetes Risk

cells may raise your risk of developing type 2 diabetes regardless of the fat in other places of your body. A new study suggests that fatty liver disease, also known as fatty liver, may be an independent risk factor for type 2 diabetes. Researchers found people with fatty liver disease were significantly more likely to develop the disease within five years than those with healthy livers. “Many patients and practitioners view fat in the liver as just ‘fat in the liver,’ but we believe that a diagnosis of fatty liver should raise an alarm for impending type 2 diabetes,” says researcher Sun Kim, MD, of Stanford University in Calif., in a news release. “Our study shows that fatty liver, as diagnosed by ultrasound, strongly predicts the development of type 2 diabetes regardless of insulin concentration.” Researchers say fatty liver often occurs along with other risk factors for diabetes, such as obesity and insulin resistance, which has made it difficult to determine whether the condition itself is a marker for diabetes risk. But in this study, researchers found that even among those with similar insulin concentrations, those with fatty liver were still twice as likely to develop type 2 diabetes. Fatty liver is a common liver condition that occurs in about one-third of adults in the U.S. In some cases, the condition is mild and causes no noticeable symptoms, but in other cases it can lead to permanent liver damage or liver failure. Fatty liver is frequently associated with alcoholic liver disease, but it may also have non-alcoholic causes. In the study, published in the Journal of Clinical Endocrinology & Metabolism, researchers looked at the relationship between fatty liver and diabetes risk in 11,091 adults in Korea. The participants' insulin concentration leve Continue reading >>

Fatty Liver Disease In Diabetes Mellitus

Fatty Liver Disease In Diabetes Mellitus

The Warren Alpert School of Medicine, Brown University, Providence, RI 02906, USA Correspondence to: Robert J. Smith, MD. The Warren Alpert School of Medicine, Brown University, 14 Arnold Street, Providence, RI 02906, USA. Email: [email protected]_j_trebor . Received 2014 Oct 24; Accepted 2014 Dec 9. Copyright 2015 Hepatobiliary Surgery and Nutrition. All rights reserved. This article has been cited by other articles in PMC. Non-alcoholic fatty liver disease (NAFLD) is highly prevalent in type 2 diabetes mellitus (T2DM), likely reflecting the frequent occurrence of obesity and insulin resistance in T2DM. NAFLD also can occur in type 1 DM (T1DM), but must be distinguished from the more common glycogen hepatopathy as a cause of hepatomegaly and liver function abnormalities in T1DM. Weight reduction achieved by diet and exercise is effective in preventing and treating NAFLD in obese diabetic subjects. Bariatric surgery also has been shown to reverse NAFLD in T2DM, and recently approved weight loss medications should be evaluated for their impact on the development and progression of NAFLD. There is limited evidence suggesting that specific drugs used for blood glucose control in T2DM [thiazolidinediones (TZDs), glucagon-like peptide-1 (GLP-1) analogs, and dipeptidyl peptidase-4 (DPP-4) inhibitors] and also statins may have a role in preventing or treating NAFLD in patients with diabetes. Keywords: Diabetes mellitus (DM), fatty liver, hepatic steatosis, non-alcoholic fatty liver disease (NAFLD), steatohepatitis Non-alcoholic fatty liver disease (NAFLD) The focus of this review is NAFLD as it relates to diabetes mellitus (DM). As the disease name suggests, NAFLD involves the presence of hepatic steatosis not caused by alcohol intake. When examined histologically, e.g., in a l Continue reading >>

Non-alcoholic Fatty Liver Disease And Type 2 Diabetes

Non-alcoholic Fatty Liver Disease And Type 2 Diabetes

Non-alcoholic Fatty Liver Disease and Type 2 Diabetes European Endocrinology, 2008; 4(2):70-3; DOI: Non-alcoholic fatty liver disease (NAFLD) was practically unheard of even 30 years ago, but is now considered one of the most common liver disorders in the US.13 It may be the most common cause of liver enzyme elevation in US adults as well as a leading cause of cirrhosis.4,5 The prevalence of NAFLD has increased in parallel with the epidemics of obesity and type 2 diabetes, which are risk factors for NAFLD.3,6 Whereas the association of type 2 diabetes with microvascular complications and macrovascular disease is well established, the association of type 2 diabetes with NAFLD is more recently recognised and probably less well-known to physicians. Furthermore, because patients are usually asymptomatic and routine blood tests are often normal, it may be a diagnosis that is overlooked in patients with type 2 diabetes.7,8 There is evidence that patients with NAFLD who have type 2 diabetes are particularly at risk of progressive forms of the disease and that they are at higher risk of developing cirrhosis compared with those who do not have diabetes.9,10 Although cardiovascular disease is the major cause of excess morbidity and mortality in type 2 diabetes, liver failure may also be a threat to patients with type 2 diabetes NAFLD.3,10 Therefore, it is important for physicians to be aware of the high likelihood that their patients with type 2 diabetes have NAFLD, as this is another potential complication that requires attention. NAFLD is characterised by fatty infiltration of the liver, mostly in the form of triglycerides, which exceeds 5% of the liver weight.11 NAFLD is histologically similar to alcoholic liver disease, but by definition it occurs in the absence of excessive Continue reading >>

Love Your Liver To Reverse Type 2 Diabetes

Love Your Liver To Reverse Type 2 Diabetes

Love Your Liver To Reverse Type 2 Diabetes Posted by:Dr. Brian Mowll onMarch 8, 2018 Modern man is lucky to have things he didnt have just a couple of hundred years ago. Electricity and running water in the home. Appliances that make life easier and more convenient. And technology that helps keep him informed and connected 24/7. But with the good things come the bad; namely, modern man is plagued with diseases that were not found in our ancestors. Disease like heart disease, obesity, cancer and type 2 diabetes were not found in primitive cultures, but have reached epidemic proportions in the last couple of decades and afflict millions of people worldwide. Type 2 diabetes, in particular, has become a modern plague, leading to blindness, amputation, kidney failure, and early death, as well as severely decreasing the quality of a persons life. By now most people understand the association between consuming large amounts of refined sugar and carbohydrates (as well as processed foods and fake fats ), and the development of type 2 diabetes. Too much sugar causes blood glucose levels to skyrocket, which causes the pancreas to have to pump out high levels of insulin to process that glucose. Over time, our pancreas gets beat up, and our cells become resistant to insulin, and we must support this natural metabolic process through artificial means, like medications and injected insulin. But this is only one pathway to diabetes. There is evidence showing the development of type 2 diabetes may also stem from certain types of sugars effect on the liver. One of the key challenges with the management of NAFLD is that not only are the vast majority of patients with early disease asymptomatic, but a substantial proportion of those with serious liver disease also display either no sympto Continue reading >>

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