Montreal study discovers more about link between diabetes and fatty liver

Research carried out in Montreal has led to a better understanding of the link between diabetes and fatty liver disease, particularly with regard to the role played by inflammation.

In laboratory experiments, the researchers found that liver cells exposed to sugar and fat begin to produce inflammatory molecules.

"In other words," said researcher Jennifer Estall, "there seems to be a cross between what is wrong with diabetes and a deterioration of inflammation in the liver."

The livers of people with diabetes also appear to be in worse condition than those of healthy people, she added.

"We think we can explain this link between diabetes and fatty liver, and why people with diabetes often have fatty liver," said Estall, who works at the Institut de recherches cliniques de Montréal.

It is estimated that between 70 and 80 per cent of people with diabetes also have hepatic steatosis, a disease resulting from the accumulation of fat in liver cells.

Hepatic steatosis is frequently asymptomatic, apart from discomfort in the abdomen around the liver, fatigue and a general feeling of malaise.

The disease is, therefore, usually diagnosed fairly late.

A diagnosis of hepatic steatosis doubles or triples the likelihood of a diagnosis of diabetes a little later on, said Estall.

"These two diseases are closely linked, and it has always been thought that inflammation could be to blame," she said. "It seems that this (inflammatory) pathway that we have found may be quite important for this link."

This inflammatory pathway has been known and studied for quite some time, she continued, but researchers now know it's expressed in two different ways: the classical way and the alternative way. The new work reveals that the alternative expression, which is less well understood, is the one that is most active in this inflammatory process.

"We could, therefore, picture one day acting on this alternative expression as a therapeutic option in the face of diabetes and hepatic steatosis," said Estall.

"This is important because we don't know the cause of diabetes or hepatic steatosis," she explained. "We have drugs to treat them, we can manage them, we can improve patients' quality of life, but we don't understand the causes, but we think we're getting closer."

This understanding, she said, could open the door to possible prevention of both diseases.

It is estimated that around 10 per cent of the Canadian population suffers from type 2 diabetes, and 25 per cent from fatty liver. That's millions of people affected by these diseases in this country alone.

"We have seen a very close correlation between this inflammatory pathway and the extent of damage to the liver," said Estall. "So, possibly, one of these inflammatory molecules could be a good biomarker for fatty liver (...) which could allow people to be diagnosed earlier, before the disease damages the liver."

The findings of this study were published in the medical journal Diabetes.

This report by The Canadian Press was first published in French on Sept. 27, 2023.