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Importance of Managing Comorbidities

variety of healthy foods displayed on counterLiving with nonalcoholic fatty liver disease (NAFLD) or nonalcoholic steatohepatitis (NASH) can be challenging. Unfortunately, adding on another condition usually makes things more complicated. Still, managing comorbidities, or having more than one condition at the same time, is key if you have NAFLD or NASH. The most common comorbidities found in people with NAFLD and NASH are obesity, metabolic syndrome, type 2 diabetes, and dyslipidemia. Since the organs in our bodies work together as a system, when there is a problem in one area, new problems can arise in other areas. In this article, we cover some of the ways that your conditions affect your NAFLD or NASH and your liver health. By effectively managing these conditions, you can help to reduce your risk of serious liver damage and improve your overall health.



Obesity is one of the greatest risk factors for NAFLD and NASH. Weight loss is viewed as key to NAFLD and NASH treatment, so your treatment plan for NAFLD or NASH will most likely be built to address your obesity.  Your doctor will likely suggest you lose at least 5% of your body weight since lowering body mass index (BMI) is strongly linked with lowering liver fat. Weight loss can also improve NASH and liver fibrosis (scarring). Weight loss can be achieved with healthy eating and regular physical activity. In addition to changing your diet and exercise techniques, medications like semaglutide can help with weight loss and may provide additional benefits for your liver. For example, in a 2021 study of stage F2 or F3 NASH patients receiving semaglutide for 72 weeks, 59% of participants achieved NASH resolution compared to 17% in the placebo group. By “resolution”, researchers meant that participants showed low levels of inflammatory cells, and no hepatocyte ballooning (cell swelling), and no worsening of liver fibrosis after 72 weeks. Please note that this is just one example of a medication that you might use in your journey. We recommend talking with your doctor about the risks and benefits of each option to decide if using medication for weight loss is right for you. By losing weight, you can decrease the amount of fat in your liver, reduce fibrosis, and improve your liver health.


Metabolic Syndrome

Metabolic syndrome is another comorbidity commonly linked with NAFLD. In fact, NAFLD is often viewed as the liver’s manifestation of metabolic syndrome. The National Institutes of Health guidelines define metabolic syndrome as having three or more of the following conditions: large waist, high triglyceride levels, low HDL cholesterol, high blood pressure, or elevated fasting blood sugar. On its own, it’s important to manage metabolic syndrome because having it increases chances of developing heart disease and type 2 diabetes. With fatty liver disease, managing metabolic syndrome is especially important since the risk of steatosis (fat in your liver) increases greatly with each additional feature of metabolic syndrome. You can manage metabolic syndrome with lifestyle changes, such as diet and exercise, and quitting smoking habits.


Type 2 Diabetes

Type 2 diabetes is frequently found among those living with NAFLD or NASH. In fact, it’s estimated that of all type 2 diabetics in the world, 55% have NAFLD and 37% have NASH. Type 2 diabetes and fatty liver have a complicated relationship where having one condition negatively affects the other. Research shows that having NAFLD is a risk factor for developing type 2 diabetes. On the other hand, if you have type 2 diabetes and fatty liver, the risk of progressing to NASH and eventually cirrhosis greatly increases. By effectively managing your diabetes, you can help reduce your risk of developing serious liver damage. This can be achieved through a combination of healthy eating, regular physical activity, and medications if needed.



Dyslipidemia is estimated to present among 69% of people with NAFLD and 72% of persons with NASH. One of the leading causes of death for NAFLD patients is cardiovascular disease. Studies suggest that dyslipidemia may be partly responsible for greater increased risk of atherosclerotic cardiovascular disease (when fat builds up in arteries), so managing dyslipidemia alongside your NAFLD or NASH is especially important for your health and overall wellbeing. Similar to other comorbidities, successful management can be achieved through a combination of healthy eating, regular physical activity, and medications, if needed.


Other Important Conditions

In addition to managing your comorbidities, you should also consider screening for other liver diseases, such as hepatitis B and C. These conditions can cause additional damage to the liver, so early detection and treatment is crucial.


Overall, managing comorbidities is essential for individuals living with NAFLD and NASH. By effectively managing obesity, metabolic syndrome, type 2 diabetes, and dyslipidemia, you can hep reduce their risk of developing serious liver damage and improve your overall health. Furthermore, regular screening for other liver diseases is also crucial for early detection and treatment. It’s important to discuss your conditions with your doctor to decide the best treatment plan for your situation. Check out our guides for starting a conversation with your doctor about how to manage comorbidities if you have NAFLD or NASH. With regular check-ups, healthy lifestyle choices and appropriate medications, you can manage comorbidities and enjoy a better quality of life.