More than 80 million North Americans suffer from Non-Alcoholic Fatty Liver Disease (NAFLD), and many do not know that they have it because most people with a fatty liver have normal liver function blood tests in the early stages of the disease. The American Association of Clinical Endocrinology, supported by the American Association for the Study of Liver Diseases, has just issued new guidelines for diagnosing and treating NAFLD (presented at the AACE Annual Meeting May 12, 2022 and published in Endocrine Practice, May 1, 2022;28(5):528-562).

A fatty liver is common even in people who never drink alcohol (Gastroenterology, August 23, 2018). Today, a fatty liver is far more likely to be caused by drinking and eating a lot of sugar-added foods and/or eating mammal meat. Since blood tests are frequently normal in early cases of NAFLD, the disease is often diagnosed with an ultrasound picture that shows fat as white spots throughout the liver.

NAFLD can usually be treated in its early stages with an anti-inflammatory diet and exercise program, any program to lose weight, and even bariatric surgery when obesity is extreme. At this time, there are no FDA-approved drugs to treat NAFLD, but some drugs such as pioglitazone or glucagon-like peptide-1 agonists may increase the benefits of lifestyle changes.

Without dramatic lifestyle changes, NAFLD can lead to diabetes, heart attacks, strokes, liver cancer, liver failure, liver transplants, and premature death. More than 70 percent of patients with Type II diabetes and more than 90 percent of obese patients with diabetes suffer from NAFLD, and more than 20 percent of those patients already have permanent damage called cirrhosis, where healthy liver tissue is replaced by scar tissue.

How Belly Fat Predicts Fatty Liver And Type II Diabetes
People who store fat primarily in their belly are also most likely to store a large amount of fat in their liver. You can often identify who is likely to have a fatty liver and Type II diabetes just by looking at a person. People who have a big belly and small buttocks are at very high risk for being diabetic and suffering heart attacks (JAMA, 2017;317(6):626-634). To prevent your blood sugar level from rising too high after you eat, your pancreas releases insulin which is supposed to lower high blood sugar levels by driving sugar from the bloodstream into the liver. However, if your liver is full of fat, the excess fat prevents the liver from accepting the sugar and blood sugar levels can rise even higher (Eur J Gastroenterol Hepatol, Dec 2016;28(12):1443-1449). A high rise in blood sugar causes high blood insulin levels that convert blood sugar to a type of fat called triglycerides. Then insulin drives triglycerides into your liver. Having high triglycerides and a fat belly increase the odds that a person has high blood insulin levels, and high blood levels of insulin constrict arteries to cause heart attacks. Insulin also acts on the brain to make you eat more, on your liver to manufacture more fat, and on the fat cells in your belly to store that fat. Skinny people with NAFLD are at high risk for diabetes and heart disease (MedPage Today, May 14, 2022).

• Storing fat in your belly is a stronger risk factor for diabetes than just being overweight and is arguably the most common cause of Type II diabetes in North America today (BMC Public Health, November 18, 2019). In one study, 11 percent of 5,228 non-obese people had excess belly fat and these normal-weight people with big bellies had significantly higher levels of blood pressure, fasting blood sugar, total cholesterol and triglyceride levels indicative of increased risk for diabetes and heart attacks.

• Measuring a person’s waist circumference is a simple and efficient way to see if people who are not overweight still are at increased risk for diabetes (Arch Med Sci Civil Dis, July 22, 2019;4:e64–e71). Men are at increased risk for being diabetic if their waist circumference is greater than 38 inches, and women if it is greater than 36 inches.

See Excess Fat in Your Liver Increases Risk for Heart Attacks, Strokes and Dementia

My Recommendations
If you have a big belly, dramatic lifestyle changes can save your life. I believe that everyone should follow an anti-inflammatory lifestyle that helps to prevent excess fat from being deposited in the liver.
• Lose weight if overweight
• Eat lots of vegetables, fruits, beans, nuts and other seeds
• Avoid sugar-added drinks (including fruit juices) and foods
• Restrict refined carbohydrates -- foods made with flour such as bakery products, pastas, and most dry breakfast cereals.
• Avoid red meat and processed meats
• Avoid smoking and recreational drugs, and avoid or restrict alcohol
• Try to exercise every day