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DIABETES AND
OBESITY

physical functioning (CdC, 2018).
The American Association of
Clinical Endocrinologists (AACE)
and American College of En-
docrinology (ACE) emphasize
complications associated with
being overweight or obese drasti-
cally increase patient suffering,
personal financial burden and
medical care costs. The AACE
and ACE (2016) define obesity as
a “complex, adiposity-based
chronic disease, where manage-
ment targets both weight-related
complications and adiposity to
improve overall health and quality
of life.”
A complication of obesity, di-
abetes and metabolic syndrome:
non-alcoholic fatty liver disease (NAFld), which is being is being weight loss of 5 percent can show improvement on the NAFld
recognized more with increased occurrence of end-stage liver dis- activity score (NAS) and a 10 percent or greater reduction in weight
ease and hepatocellular carcinoma (HCC). It has been estimated can improve fibrosis by at least one stage (Romero-Gomez, Zelber-
that at least 40 percent of the population in the industrialized West Sagi and Trenell, 2017). dietary modifications such as reduction in
suffers from NAFld. (Patel, Torres, and Harrison (2009). About overall carbohydrate intake, refined sugar, and increase in omega 3
31 percent of the U.S. population is affected by NAFld, with at fatty acids are often suggested. Pharmacological interventions uti-
least an 88 percent incidence of NAFld in the morbid obese pop- lized even in the non-diabetic population often include pioglitazone,
ulation (blendea, Thompson Malkani (2010). NAFld can progress liraglutide, vitamin E and pentoxiphylline (barb, Portillo-Sanchez &
to cirrhosis from continued inflammation and fibrosis via multiple Cusi, 2016). Most recently, empagliflozin (Jardiance) a sodium glu-
inflammatory pathways related to obesity, diabetes, etc. Since liver cose cotransporter-2 inhibitor (SGlT-2) was studied for its effects
disease can progress in the face of normal liver enzymes, AST and on NAFld in the type 2 diabetic population. The data was prom-
AlT, American College of Gastroenterology (ACG) practice ising, revealing subjects who received empagliflozin benefited from
guidelines (2016) now recommend lower AlT reference ranges 29 a reduction in liver fat from 16.2 percent to 11.3 percent; compared
to 33 IU/l for males and 19 to 25 IU/l for females to increase to the control group with a decrease from 16.4 percent to 15.5 per-
awareness and encourage early intervention. Hepatocellular carci- cent (Kuchay et al., 2018).
noma associated with NAFld is generally more aggressive due to AACE and ACE Clinical Practice Guidelines for Comprehensive
diagnosis most often occurring in the later stages of the disease Medical Care of Patients with Obesity (2016) recommend using not
process, larger tumors and fewer curative options (Said & Ghufran, only body mass index (bMI) to diagnose obesity but to consider
2017). It is estimated that hepatocellular carcinoma may be the also the severity of systemic effects related to adiposity. Ultimately,
leading cause for liver transplantation in the next decade and con- the goal in treating obesity is to improve patient health and quality
sists of 90 percent of liver cancer cases (Cholankeril, Patel, Khu- of life as well as decrease complications associated with obesity and
rana & Satapathy, 2017). not necessarily achieve a “preset decline in body weight” (AACE &
lifestyle modifications can effectively reduce NAFld. A modest ACE, 2016).
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