If you have type 2 diabetes, you’re at much greater risk for fatty liver disease

Allison Horton

For many years, Abraham Aviv had suffered from nonalcoholic fatty liver disease.

A year and a half ago, his condition progressed to cirrhosis, which permanently scars and hardens the liver.

Aziz, 66, needed a liver transplant, but the number of people waiting for a new liver was greater than available donors (deceased or alive). The liver is the only organ that can regenerate, making it possible for a person to donate a portion of their liver.

His wife and children weren’t a match. But his 27-year-old daughter Shiri’s boyfriend of three years, Nikko Velazquez, 29, was. Yet Aziz, who has type 2 diabetes, and his daughter were reluctant for Velazquez to be tested as a donor.

“I didn’t want any young guy in the family having the surgery,” Aziz said. “He was the one who pushed it. I owe him my life.”

Non-alcoholic fatty liver disease is common in the type 2 diabetic population, said Dr. Kawtar Al Khalloufi, a hepatologist at Cleveland Clinic Florida-Weston, where Aziz was referred after being diagnosed with cirrhosis.

The condition occurs 40-50 percent in type 2 diabetic patients, and 70 percent in patients who have type 2 diabetes and are obese.

Al Khalloufi also noted a person can have lean fatty liver disease and not be overweight nor have diabetes. Rather, they can have a genetic predisposition to the condition, which is seen more frequently in the Asian population.

Aziz, who was not overweight, was diagnosed with the disease before he became diabetic years later.

Fatty liver disease is sometimes called a silent liver disease because the condition can develop and escalate without symptoms. A routine blood test to check the liver can detect it.

“If you catch fatty liver disease early, it is possible you can do something about it and reverse the condition,” Al Khalloufi said. “You can reverse it with weight loss through diet and exercise.”

A 7 to 10 percent weight loss is effective in reversing fatty liver disease, Al Khalloufi said. It is helpful to follow a Mediterranean diet, which is low in fat and can lead to weight loss.

Meanwhile, a University of Florida study could increase detection of nonalcoholic fatty liver disease with patients who have type 2 diabetes. Researchers will test 1,000 people with type 2 diabetes for nonalcoholic fatty liver disease, liver inflammation, scarring and cirrhosis.

The study will employ FibroScan, an ultrasound that can detect the condition more reliably than traditional methods.

Cirrhosis can’t be reversed so it is important to diagnose nonalcoholic fatty liver disease, linked to an increased risk of liver cancer and heart or kidney disease, early so a liver transplant won’t be necessary.

Not everyone with NAFLD will develop inflammation or cirrhosis. Researchers don’t know why some patients with type 2 diabetes develop a fatty liver, while others do not, even when obese.

Research indicates 10 percent of children and 20 percent of adults have NAFLD. Type 2 diabetics appear to be especially prone, with preliminary research suggesting up to two-thirds suffer from a fatty liver. Scientists believe up to 5 percent of type 2 diabetics have cirrhosis.

“For more than a decade, hepatitis C used to be the No. 1 cause of liver transplants,” Al Khalloufi said. “But now, nonalcohol fatty liver disease is the No. 1 cause.”

In August, Aviv underwent liver transplant surgery with Velazquez as his donor. Velazquez credits his mother for becoming a donor.

“I saw him getting skinny and he wasn’t moving around as much,” Velazquez said. “It was a dramatic change. I wanted to be tested as a donor because of my mom. She taught us to give whenever possible.”

Since being released from the hospital in October, Aziz’s liver function has improved and he will continue to take anti-rejection drugs for the rest of his life.

He no longer appears to be diabetic, an offshoot of the surgery that has surprised him and his doctor. He walks two miles daily in his neighborhood and looks forward to when he can get back to weightlifting and working out at the gym.

Velazquez was walking around the next day after the surgery.

“I wasn’t excited or scared,” Velazquez said. “I was really calm. I just wanted to donate my liver. The recovery has been awesome.”

Velazquez wants people to be aware of the benefits of liver donation.

“Not a lot of people are aware that you can save a life and you will be fine, too,” said Velazquez, who is not on any medication following the surgery. “The liver grows back. You can give a liver donation and save a life.”

Since the surgery, Aziz has retired and turned over his construction and roofing businesses for his children to run. He is the father of five adult children and six grandchildren.

“Nikko was a part of the family before the surgery,” Aziz said. “He saved my life.”