Fatty Liver and Diabetes

Metabolic Syndrome

Metabolic syndrome refers to a combination of various risk factors that together significantly increase the risk of serious conditions such as heart attack, stroke, and type 2 diabetes. This combination is particularly dangerous because it often remains symptom-free until serious complications arise.

The prevalence of metabolic syndrome is steadily increasing worldwide, especially in developing countries and among younger people. Estimates suggest that between 20% and 40% of these populations are affected by metabolic syndrome and/or insulin resistance.

The WHO emphasizes that early intervention can help prevent or delay the development of metabolic syndrome and its complications.

Info Box: Metabolic syndrome was previously known as "Syndrome X" when the exact causes and connections of the syndrome were not yet fully understood. The "X" represented the unknown.

Detecting Metabolic Syndrome Early

There are specific blood values that can be measured to identify the risk and effects of metabolic syndrome at an early stage. These markers include blood lipid levels such as triglycerides, HDL cholesterol, LDL cholesterol, non-HDL cholesterol, and total cholesterol, which indicate the presence of lipid metabolism disorders often associated with metabolic syndrome. Additionally, various blood sugar markers can help identify potential signs of insulin resistance or type 2 diabetes. Elevated markers for chronic inflammation in the body can increase the risk of cardiovascular diseases. By measuring and monitoring these biomarkers, potential risks can be identified early, allowing for targeted prevention and treatment measures. A detailed list of all blood markers examined in the Aeon Check-up can be found on this page.

Definition of Metabolic Syndrome

Metabolic syndrome is defined by the simultaneous presence of at least three factors, which include abdominal obesity (increased waist circumference), high blood pressure, elevated fasting blood sugar, elevated blood lipid levels, and low HDL cholesterol. The concurrent presence of these factors significantly increases the risk of serious conditions such as cardiovascular diseases, type 2 diabetes, and stroke.

• Abdominal Obesity: Severe overweight, particularly in the form of abdominal obesity (an increased waist circumference), is considered a central risk factor and is often a diagnostic criterion for metabolic syndrome. Belly fat (visceral fat) is more metabolically active than fat in other body areas and releases more signaling molecules that can promote inflammation and contribute to insulin resistance.
• High Blood Pressure: Hypertension adds extra strain on the heart and blood vessels, thereby increasing the risk of serious cardiovascular events such as heart attack and stroke. If left untreated, high blood pressure can also lead to kidney damage, heart failure, and other health issues.
• Elevated Fasting Blood Sugar: An elevated fasting blood sugar level (i.e., after a prolonged fasting period) may indicate impaired glucose tolerance or even existing type 2 diabetes. Elevated fasting blood sugar should be taken seriously, as untreated diabetes can have severe consequences, including cardiovascular disease, kidney damage, nerve damage, and even vision impairment.
• Elevated Blood Lipids: High triglyceride levels combined with low HDL cholesterol are typical signs of dyslipidemia, which often occurs in connection with metabolic syndrome. Studies show that people prone to weight gain who have these unfavorable blood lipid levels also have an increased concentration of small, dense LDL cholesterol particles in their blood. These are considered particularly atherogenic, meaning they promote the development of atherosclerosis. People with high concentrations of these particles have an increased risk of cardiovascular disease.
• Low HDL Cholesterol: A deficiency of HDL cholesterol encourages the formation of deposits in the arteries, which can, over time, narrow the blood vessels and lead to severe cardiovascular diseases like heart attack or stroke.

Causes of Metabolic Syndrome

In most cases, metabolic syndrome is caused by an unhealthy lifestyle, particularly due to lack of physical activity and an unbalanced diet, as well as being overweight or obese. These factors can lead to conditions such as insulin resistance, which in turn promotes the development of metabolic syndrome and its individual components.

Overweight and Obesity

A diet high in saturated fats, trans fats, sugar, and processed foods increases the risk of overweight, obesity, insulin resistance, and other metabolic disorders.

Link Between Overweight and Type 2 Diabetes Weight gain significantly increases the risk of diabetes. Studies show that up to 65% of type 2 diabetes cases can be attributed to being overweight. The Nurses' Health Study also illustrates the connection between rising BMI and diabetes risk: individuals with a BMI below 22 kg/m² had the lowest risk of developing diabetes. As BMI increased, the relative risk grew exponentially, reaching a 40-fold (4000%) increase at a BMI of 35 kg/m².

Similar results were found in the Health Professionals Follow-Up Study for men, where the lowest risk was observed with a BMI below 24 kg/m². In men with a BMI over 35 kg/m², the age-adjusted relative risk for diabetes rose by over 6000%.

However, it is not only overweight and obesity that serve as risk factors for metabolic syndrome but also the distribution of body fat itself plays a critical role. Body Mass Index (BMI) alone is not a particularly reliable indicator of body fat percentage. In most studies comparing estimated total body fat with a reference method, BMI could only explain about 70-80% of the differences in body fat percentage.

Therefore, waist circumference is a similarly good predictor of body fat percentage and may be an even better indicator of cardiovascular disease risk. It can identify individuals with a relatively low BMI but a high amount of abdominal fat, which is associated with increased health risks.

Visceral Fat

What is Visceral Fat? Visceral fat is the fat that accumulates in the abdominal cavity around internal organs like the liver, pancreas, and intestines. Unlike subcutaneous fat (fat under the skin), visceral fat located around the internal organs in the abdomen is metabolically very active. It releases hormones and other substances that can trigger inflammation and thus promote insulin resistance.

How Does Visceral Fat Lead to Diabetes? Inflammatory substances released by visceral fat can increase insulin resistance by impairing the effectiveness of insulin. This leads to elevated blood sugar levels and can eventually cause type 2 diabetes.

Measures to Reduce Visceral Fat

• Healthy Diet: A diet rich in fruits, vegetables, whole grains, and lean proteins, with limited sugar and saturated fats, helps reduce visceral fat.
• Regular Exercise: Physical activity, especially endurance and strength training, helps reduce visceral fat and improve insulin sensitivity.
• Stress Management: Chronic stress can promote the accumulation of visceral fat. Relaxation techniques like yoga or meditation can help reduce stress.

Insulin Resistance

Lung Cancer Lung cancer is one of the most common cancers worldwide and the leading cause of cancer-related death. In its early stages, lung cancer often causes no symptoms or only nonspecific symptoms like cough, shortness of breath, or chest pain, which can easily be mistaken for other conditions. This often delays diagnosis until the cancer has already advanced. Certain types of lung cancer, particularly small cell lung cancer, are characterized by especially rapid and uncontrolled growth, causing the tumor to increase in size and destroy surrounding tissue in a short time. Lung cancer cells also have the ability to detach from the primary tumor in early stages of the disease and spread through blood and lymphatic vessels to other organs (metastasis). This creates secondary tumors (metastases), complicating treatment and worsening the prognosis. Risk factors such as smoking, secondhand smoke, and exposure to harmful substances increase the risk of the disease. Five-year survival rates after diagnosis are around 25% for women and 19% for men.

Although MRI is a powerful imaging technique, some cancers, like lung cancer, are only partially visible with it. Due to the unique structure of lung tissue and the fact that lung cancer often appears as very small or poorly defined lesions, MRI can reach its limits in these cases. Additionally, respiratory movement complicates the imaging, further hindering the detection of small tumors. Therefore, other imaging methods such as computed tomography (CT) are often used for early detection of lung cancer, as they offer higher sensitivity in this specific context.

What is Insulin Resistance? Insulin is essential for regulating blood sugar levels. In insulin resistance, cells can no longer properly absorb glucose (sugar), leading to chronically elevated blood sugar levels and an increased risk of type 2 diabetes. This not only impairs glucose uptake in muscle and fat cells but also leads to increased fat storage in the liver, which can contribute to the development of fatty liver disease. Fatty liver can, in turn, progress to other liver conditions, such as non-alcoholic steatohepatitis (NASH), which can lead to liver cirrhosis and liver failure.

Causes and Symptoms Overweight, especially visceral fat (abdominal fat), physical inactivity, an unhealthy diet, and genetic factors can contribute to insulin resistance.

Insulin resistance itself often causes no noticeable symptoms. However, over time, it can lead to symptoms like fatigue, increased thirst, and frequent urination, which are typical of diabetes.

Genetic Factors

Some people have a genetic predisposition for metabolic syndrome. Family and twin studies suggest that susceptibility to metabolic syndrome and its individual components (such as high blood pressure, high blood sugar, obesity, etc.) is significantly influenced by genetics, accounting for about 50%. This means that individuals with affected family members are more likely to develop these traits.

Scientists have identified specific gene mutations associated with individual features of metabolic syndrome. For example, researchers found a genetic alteration in the enzyme Dyrk1B, which leads to an inherited form of metabolic syndrome with early-onset coronary heart disease. This gene alteration makes Dyrk1B overactive, which results in the formation of more fat cells, increased sugar production in the body, and impacts cell growth.

Symptoms of Metabolic Syndrome

Metabolic syndrome itself often does not cause specific symptoms. However, it is important to watch for individual risk factors that may indicate its presence, such as:

• Increasing Waist Circumference: Excess fat accumulation in the abdominal area (abdominal obesity) is a common and visible sign of metabolic syndrome.
• High Blood Pressure: High blood pressure often causes no noticeable symptoms but can lead to serious health problems over time. Regular blood pressure checks can help detect metabolic syndrome early.
• Fatigue and Low Energy: Although fatigue can have many causes, it can also be a sign of impaired glucose tolerance or existing diabetes, especially when combined with other risk factors.
• Increased Thirst and Frequent Urination: These symptoms may indicate elevated blood sugar levels, which can be a sign of diabetes. Skin Changes: Dark discoloration of skin folds (acanthosis nigricans) can be a sign of insulin resistance.
• Elevated Blood Lipids: While elevated blood lipid levels usually do not cause immediate symptoms, they can lead to serious cardiovascular problems over time.

Common Diseases Associated with Metabolic Syndrome

Fatty Liver (Hepatic Steatosis)

• Definition: An excessive accumulation of fat in the liver, often caused by overweight, insulin resistance, unhealthy diet, and excessive alcohol consumption.

• Symptoms: In the early stages, there are usually no symptoms or only nonspecific symptoms like mild fatigue or a feeling of pressure in the upper right abdomen. In advanced stages, symptoms may include fatigue, loss of appetite, pain in the upper right abdomen, jaundice (yellowing of the skin and eyes), and liver enlargement.

Liver Cirrhosis

• Definition: An irreversible damage to the liver in which healthy liver tissue is replaced by scar tissue. This significantly impairs liver function and can lead to life-threatening complications. Common causes include long-standing fatty liver, chronic hepatitis, or excessive alcohol consumption.

• Symptoms: In the early stages, there are often no symptoms or only nonspecific symptoms such as fatigue, weakness, and loss of appetite. In advanced stages, the following symptoms may occur:
  • Fatigue, weakness, weight loss, loss of appetite
  • Jaundice (yellowing of the skin and eyes)
  • Itching
  • Abdominal pain and swelling (ascites)
  • Bleeding from varices in the esophagus (esophageal varices)
  • Confusion and other neurological symptoms (hepatic encephalopathy)

Coronary Heart Disease

• Definition: A condition in which the coronary arteries, which supply blood and oxygen to the heart, are narrowed or blocked, usually due to atherosclerosis (deposits of fat and other substances in the arterial walls).
• Symptoms:
  • Angina Pectoris (Chest Pain): A feeling of tightness or pressure in the chest, often triggered by physical exertion or stress. Shortness of Breath: Difficulty breathing, especially during physical activity or when lying down. In advanced coronary heart disease, this may also occur at rest.
  • Heart Attack (Acute Myocardial Infarction): Sudden, severe chest pain that may radiate to the arm, jaw, upper abdomen, or back, accompanied by sweating, nausea, and weakness.
  • Heart Failure: When the heart can no longer pump enough blood due to reduced blood supply, symptoms such as fatigue, swollen legs, and shortness of breath may develop.

Diabetes

• Definition: A chronic metabolic disease characterized by persistently elevated blood sugar levels.
• Types of Diabetes:
  • Type 1 Diabetes: Results from the destruction of insulin-producing cells in the pancreas. As a result, the body lacks the hormone insulin, which is necessary for the uptake of glucose (sugar) from the blood into the cells.
  • Type 2 Diabetes: Usually develops in adulthood and is characterized by insulin resistance. This means that body cells do not respond adequately to insulin, even though it is present.
• Causes:
  • Type 1 Diabetes: The exact causes are not fully understood, but it is an autoimmune disease in which the immune system mistakenly attacks insulin-producing cells.
  • Type 2 Diabetes: The main causes are overweight, lack of physical activity, and an unhealthy diet. These factors can lead to insulin resistance. Genetic predisposition and other factors also play a role.
• Symptoms:
  • Fatigue and lethargy
  • Increased thirst and frequent urination
  • Blurred vision
  • Slow-healing wounds
  • Other possible symptoms: Weight loss (especially in Type 1 Diabetes), increased susceptibility to infections, tingling or numbness in hands and feet (neuropathy), skin problems.

Pancreatic Cancer

• Definition: A malignant condition in which cancer cells multiply uncontrollably in the pancreas. It is considered particularly aggressive and often has a poor prognosis.
• Symptoms: Often, there are no symptoms in the early stages. Later on, symptoms may include jaundice, abdominal pain, weight loss, nausea, vomiting, digestive disorders, and loss of appetite. Pancreatic cancer is frequently diagnosed only at an advanced stage when symptoms have already appeared.

Pancreatic Lipomatosis

• Definition: A benign condition in which healthy tissue in the pancreas is gradually replaced by fatty tissue. It often occurs in association with overweight, metabolic syndrome, and advanced age.
• Symptoms: In many cases, pancreatic lipomatosis causes no discomfort and is discovered incidentally during imaging studies. Digestive disorders such as diarrhea or fatty stools may occur if the function of the pancreas is impaired. There is also an increased risk of developing diabetes, as insulin production may be affected.

Colon Cancer

• Definition: Colon cancer, also known as colorectal carcinoma, is a malignant condition in which cancer cells multiply uncontrollably in the large intestine (colon) or rectum. It usually develops from benign precursors called polyps, which can evolve into malignant tumors over time. Studies have shown that individuals with metabolic syndrome have a higher risk of colon cancer, particularly for early-onset colon cancer (before the age of 50).
• Symptoms: Colon cancer can remain asymptomatic for a long time or cause nonspecific complaints, making early diagnosis difficult. Possible signs include:
  • Changes in bowel habits (diarrhea, constipation)
  • Blood in or on the stool
  • Abdominal pain and cramping
  • Weight loss
  • Anemia
  • Nausea and vomiting

Infertility

• Definition: Infertility is defined as the inability to achieve pregnancy after 12 months of regular unprotected intercourse. In women over 35 years of age, infertility is recognized after 6 months. Several studies indicate an impact of metabolic syndrome on fertility in both women and men.
• Symptoms and Effects in Women:
  • Hormonal imbalance affecting ovulation and egg quality
  • Increased risk of Polycystic Ovary Syndrome (PCOS)
  • Higher risk of pregnancy complications such as gestational diabetes, preeclampsia, and preterm birth
• Symptoms and Effects in Men:
  • Reduced testosterone levels affecting sperm production and quality
  • Erectile dysfunction
  • Oxidative stress damaging sperm and decreasing motility

Diagnosis of Metabolic Syndrome

The diagnosis of metabolic syndrome is made through various examinations, including measuring waist circumference and laboratory tests to determine different blood values. There are several definitions and criteria for diagnosis, with the most common being those of the International Diabetes Federation (IDF) and the Adult Treatment Panel III (ATP III).

Criteria of the International Diabetes Federation (IDF)

• Abdominal Obesity: Waist circumference ≥ 94 cm in men, ≥ 80 cm in women Additionally, at least two of the following four factors:
• Increased Blood Lipids: ≥ 150 mg/dL (1.7 mmol/L)
• Low HDL Cholesterol: < 40 mg/dL (1.03 mmol/L) in men or < 50 mg/dL (1.29 mmol/L) in women
• Increased Blood Pressure: Systolic blood pressure ≥ 130 mmHg or diastolic blood pressure ≥ 85 mmHg
• Increased Fasting Blood Sugar: ≥ 100 mg/dL (5.6 mmol/L) or already diagnosed Type 2 Diabetes

Criteria of the Adult Treatment Panel III (ATP III)

• At least three of the following five components:
  • Abdominal Obesity: Waist circumference > 102 cm in men, > 88 cm in women Increased Blood Lipids: ≥ 150 mg/dL (1.7 mmol/L)
  • Low HDL Cholesterol: < 40 mg/dL (1.03 mmol/L) in men, < 50 mg/dL (1.29 mmol/L) in women
  • Increased Blood Pressure: Systolic blood pressure ≥ 130 mmHg or diastolic blood pressure ≥ 85 mmHg
  • Increased Fasting Blood Sugar: ≥ 100 mg/dL (5.6 mmol/L) or already diagnosed Type 2 Diabetes

Additional Examinations

• Physical Examination: Assessment of overall health status, measurement of blood pressure and body weight, determination of body mass index (BMI)
• Blood Tests: Measurement of fasting blood sugar levels (fasting blood glucose), triglycerides, HDL and LDL cholesterol, and possibly other parameters such as liver function tests or kidney function
• Further Investigations: Depending on individual risk, additional tests such as an ECG, ultrasound examination of abdominal organs, or a stress test may be required.

Info Box: Can metabolic syndrome be detected in an MRI?

No, metabolic syndrome itself cannot be detected in an MRI. However, signs of it may be visible. These include excessive fat deposition in the liver, the distribution of fat tissue in the body, and the amount of visceral fat in the abdominal cavity.

Prevention and Management of Metabolic Syndrome

Lifestyle Changes

• Dietary Changes: A balanced diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats. Limit sugar, saturated fats, and trans fats. Foods with high satiety value, such as fiber-rich foods, proteins, and healthy fats, can help prolong the feeling of fullness and reduce cravings.
• Physical Activity: Regular physical activity, with at least 150 minutes of moderate exercise or 75 minutes of vigorous exercise per week, can lead to improvements in metabolic symptoms. Additionally, strength training is recommended twice a week.
• Weight Loss: Weight loss, particularly in the abdominal area, can improve insulin resistance and reduce other risk factors. A study found that even a moderate weight loss of 6.5% after 4 weeks led to significant improvements in several risk factors (blood pressure, blood sugar levels, and total cholesterol). These positive effects were maintained throughout the active weight loss phase (averaging 16.7 weeks), with blood pressure and triglycerides even continuing to decrease. The achieved weight reduction of 15.1% correlated directly with the improvement of each individual criterion.
• Stress Management: A crucial component of managing the syndrome is behavioral change, particularly to avoid stress-related eating or cravings. Techniques such as yoga, meditation, or deep breathing can help reduce stress. Avoiding Smoking and Alcohol Consumption: A healthy lifestyle through abstaining from smoking and alcohol can lower the risk of metabolic syndrome. Tobacco use is associated with reduced insulin sensitivity and the development of insulin resistance. Even short-term tobacco use leads to the development of insulin resistance.

Medication Treatment

• Medications: Sometimes, medications are necessary to control blood pressure, blood sugar, or cholesterol levels. Statins, which inhibit cholesterol production in the liver, effectively lower LDL cholesterol, which is often elevated in people with metabolic syndrome. By doing so, statins reduce the risk of atherosclerosis and associated cardiovascular diseases.
• Regular Check-ups: Regular doctor visits to monitor risk factors (cholesterol levels, glucose metabolism, etc.) and to adjust treatment as needed are important for managing metabolic syndrome as effectively as possible.

Summary and Conclusion

Metabolic syndrome is a combination of various risk factors that significantly increase the risk of serious diseases such as cardiovascular disorders, type 2 diabetes, and stroke. The central criteria include abdominal obesity, elevated blood pressure, increased fasting blood sugar, and unfavorable blood lipid levels (elevated triglycerides and low HDL cholesterol).

The main causes are unhealthy lifestyle habits such as poor diet, physical inactivity, and overweight, particularly visceral fat in the abdominal area. Additionally, genetic factors play an important role. The syndrome is closely associated with a variety of diseases, including fatty liver, coronary heart disease, diabetes, and certain types of cancer.

Metabolic syndrome poses a serious health threat, especially as it often remains undetected until severe complications arise. Early detection and targeted intervention through healthy lifestyle choices are essential to minimize risks. Given the increasing prevalence, even among younger individuals, it is important to raise awareness about the significance of a healthy lifestyle to prevent the occurrence and consequences of metabolic syndrome.