Metabolic-associated fatty liver disease: Know what causes it and how to prevent it

Study unveils elevated cardiovascular risk in type 2 diabetes patients with non-alcoholic fatty liver disease which is also referred as metabolic-associated fatty liver disease (MAFLD)

Metabolic-associated fatty liver disease (MAFLD) has indeed become a growing concern for India, with a study conducted by the Institute of Liver and Biliary Sciences (ILBS) indicating that 56% of the total (over 6,000) respondents have metabolic-associated fatty liver disease (MAFLD) [previously known as non-alcoholic fatty liver disease (NAFLD)].

A new concerning trend is also emerging in recent studies indicating that patients of MAFLD who also type-2 diabetes have are at a greater risk of cardiovascular diseases - however, understanding of the mechanisms of how the cardiovascular risks is increased, is still emerging.

A study published in the BMJ in 2024 indicated that both MAFLD and T2DM contribute to a state of chronic, low-level inflammation throughout the body, which may be responsible for promoting the development of atherosclerosis (a condition characterized by fatty deposits within the arteries). The underlying cause is thought to be the secretion of various cytokines and acute-phase proteins by the body in response to this chronic inflammation.

While the exact link between MAFLD and cardiovascular disease in type 2 diabetes remains unclear, several potential contributing factors exist. Both conditions likely promote atherosclerosis (the hardening of arteries), through chronic inflammation and abnormal cholesterol levels. Additionally, other facts such as fluctuation/changes in blood clotting tendencies might further increase the risk of cardiovascular disease in these patients.

Causes:

Lifestyle significantly impacts both the development and treatment of MAFLD. Dietary practices that exacerbate hypertriglyceridemia (elevated triglycerides), hyperglycaemia (high blood sugar, both fasting and postprandial), insulin resistance, and weight gain are associated with a heightened risk of developing MAFLD.

Both type 2 diabetes and impaired glucose tolerance represent significant risk factors for developing MAFLD. Type 2 diabetes is characterised by insulin resistance, elevated blood sugar (hyperglycaemia), high triglyceride levels (hypertriglyceridemia), increased flow of free fatty acids from adipose tissue to the liver, and an accumulation of visceral fat. These characteristics collectively contribute to an increased risk of MAFLD.

Precautions/Preventions

The foundation of MAFLD treatment lies in modifying lifestyle habits. This primarily involves adopting heart-healthy dietary patterns to achieve sustained weight loss, improve insulin sensitivity, and reduce cardiometabolic risk factors linked to metabolic syndrome. Importantly, even a modest 5-10% reduction in body weight can significantly improve liver health, with positive effects noticeable even after a 5% weight loss.

In managing MAFLD, exercise constitutes another crucial lifestyle intervention. It substantially reduces hepatic steatosis (fatty liver), enhances the uptake of free fatty acids by muscle cells (myocytes), and improves insulin sensitivity, even in the absence of weight loss.

(Author: Dr Rohini Nagarkar, Senior Consultant Pediatrics, Surya Mother and child super speciality hospital, Pune)