New Insights into Fatty Liver Disease and Sex Hormones in Diabetic Men

Fatty liver disease is very common, especially among people with diabetes, metabolic issues like high cholesterol, high blood pressure, heart diseases, and those with sedentary lifestyles.

Unfortunately, there are no specific markers to predict who will develop fatty liver disease, and no specific therapies have been approved for it yet.

Known risk factors include uncontrolled diabetes, a sedentary lifestyle, family history, obesity, and other metabolic conditions.

Exciting new research has shown that sex hormones might play a role in fat metabolism and could influence the risk of developing fatty liver disease.

A recent study published in BMC Endocrine Disorders explored how these hormones impact the chances of developing metabolic dysfunction-associated fatty liver disease (MAFLD) in men and women with type 2 diabetes.

Key findings of the study and sex differences:

The research revealed that sex hormones might predict the risk of developing fatty liver in diabetic men.

Some key findings of the study are mentioned below:

Fatty liver disease is very common in people with diabetes, with nearly equal prevalence in men and women, though men have a slightly higher risk.

• Prevalence of MAFLD in men: 65.6%
• Prevalence of MAFLD in women: 61.1%

In diabetic men, the levels of sex hormones and thyroid hormones differed between those with and without MAFLD:

These differences suggest that sex hormones and thyroid hormones might play a role in the development of MAFLD in diabetic men.

The research revealed that in men with T2DM:

• Higher levels of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) were linked to a decreased risk of MAFLD.

• On the other hand, men with metabolic dysfunction-associated fatty liver disease (MAFLD) had higher progesterone levels compared to men without the condition.

No significant association in women:

Interestingly, the study found no statistically significant associations between sex or thyroid-related hormones and MAFLD risk in women with T2DM.

This suggests potential hormonal differences in how MAFLD develops between the sexes.

The table below summarizes the sex hormone levels in men and women with T2DM and MAFLD.

The overall prevalence of fatty liver disease:

The study also highlighted the high prevalence of MAFLD in the study population. Around 64% of the participants with T2DM were diagnosed with MAFLD, underlining the significant overlap between these conditions.

Limitations and further research:

Even though this study has provided us with some good insights, it still has some limitations.

The research was cross-sectional, meaning it looked at data from one specific time and could not prove what causes what.

Moreover, we need longitudinal studies to find out how hormonal changes over time can affect MALFD development and progression in both diabetic men and women.

Also, if we understand the mechanism of how FSH, LH, and progesterone are related to MAFLD, then more research could be conducted.

Public health significance:

This research has helped us understand the relationship between hormones, diabetes, and liver health.

It also highlights the fact that sex differences must be considered when evaluating MALFD risk factors and when prescribing a treatment approach.

For individuals with T2DM:

If you are worried about MAFLD then you should talk to your doctor as he/she can help you analyze the risk factors like hormone levels. They will also suggest the best approach and screening or treatment options.

Furthermore, following a balanced diet, regular exercise, weight management, and maintaining a healthy lifestyle will always be important for treating T2DM. These techniques will help you reduce the chances of MAFLD and related complications.

Recognizing the signs and symptoms of NAFLD in T2DM

In the early stages of life, many people don’t know about their liver condition, whether they have normal or fatty liver, i.e., non-alcohol fatty liver disease (NAFLD).

It’s imperative to be conscious of the vital signs and symptoms that might develop with time. Unfortunately, NAFLD doesn’t cause any pain or distress in the beginning.

Without proper screening or performing tests, it is very difficult to detect this disease. On the other hand, some people having NAFLD may experience certain symptoms with the progression of the disease.

One of the common symptoms is tiredness [ref], which is likely to be in primary biliary cirrhosis patients and associated with impairment in physical function.

You might find yourself feeling constantly tired, even after getting enough sleep. Another vital sign is right upper abdominal pain or discomfort [ref].

It is also important to keep in mind that said symptoms can also be caused by other health conditions or diseases associated with you.

If you experience any of these health problems/issues, you must consult with your doctor to determine the real cause of the disease.

Early detection of NAFLD may help to overcome the disease with the help of regular medical checkups and consultation with a specific doctor.

During visits, liver condition and its functionality may be tested with the help of regular blood tests, screening, and scanning.

Living well with T2DM and NAFLD

It is difficult to live with both type 2 diabetes (T2DM) and NAFLD at the same time.

However, the good news is that affected people can manage their lives efficiently through positive lifestyle changes and adopting a better healthcare system.

Self-care is your superpower:

Self-care plays a vital role in the successful management of both type 2 diabetes mellitus (T2DM) and non-alcoholic fatty liver disease (NAFLD).

Some essential steps like healthy food, enough sleep, regular exercise, yoga, and meditation can help you manage the conditions.  

Research shows that physical activity and healthy habits can help prevent metabolic dysfunction-associated fatty liver disease (MAFLD).

The best evidence suggests that doing moderate to vigorous aerobic exercise for 150-240 minutes each week is most effective [ref].  

Release stress:

Research proves that stress could increase the occurrence rates of NAFLD [ref].

When you’re stressed, your body releases hormones that can raise blood sugar levels and cause fat to build up in the liver.

This can make fatty liver disease worse, especially if you have type 2 diabetes. Therefore, find out the causes of stress and overcome it with the help of relaxation techniques like yoga, meditation, or deep breathing.

Common treatments for fatty liver disease:

Commonly used medicines to treat fatty liver disease, although not proven in studies, include:

• LOLA (l-ornithine l-aspartate) is not available in the US
• Silymarin (derived from milk thistle)
• Vitamin E (anti-oxidant)
• Ursodeoxycholic acid (cell protective effects)
• thiazolidinediones/ peroxisome proliferator-activated receptor-γ (troglitazone, rosiglitazone, and pioglitazone) (lowers free fatty acid levels and increases adiponectin levels)

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[I had a patient with MAFLD whose ALT (SGPT) levels ranged from 190 to 310 U/L. Despite trying various medications, his ALT would only drop to 80 U/L.

Later, he developed diabetes and had to switch to a low-calorie, low-glycemic diet, eliminating processed foods and simple carbs.

As a result, his ALT levels dropped to 30 U/L without any medications.

Thus, diet and exercise are of utmost importance in reducing liver inflammation and treating NAFLD (fatty liver)]

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The only FDA-approved medicine to treat MAFLD or fatty liver is Resmetirom (Rezdiffra). It was approved on March 14, 2024, for patients with moderate to advanced hepatic fibrosis.

In conclusion:

Fatty liver disease is very common. Markers to predict the development of fatty liver disease are not clear.

A recent study highlighted the association of sex hormones with the development of fatty liver disease in men with type 2 diabetes.