The metabolic impact of non-alcoholic fatty liver disease (NAFLD) is more severe in people with type 2 diabetes, according to new research.

The study, which was conducted at the University of Florida, analysed data from 154 participants, all of whom were obese. These participants were then split into four groups: the first group had type 2 diabetes but not non-alcoholic fatty liver disease; the second had type 2 diabetes with stage one of NAFLD; the third group had type 2 diabetes with stage two of NAFLD; and the fourth group was a control with neither type 2 diabetes nor NAFLD.

The researchers discovered that those participants who had type 2 diabetes plus stage one or two of NAFLD had higher triglyceride levels in the liver compared to the other two groups, which suggests they had a higher risk of heart and stroke. There was no difference between the two first group (which only had type 2 diabetes) and the control group, indicating that type 2 diabetes is not in itself a factor.

“In middle-aged obese patients with [type 2 diabetes], the presence of NAFLD is associated with hyperinsulinemia and more severe adipose tissue and hepatic insulin resistance, as well as worse atherogenic dyslipidemia,” the authors wrote.

“The clinical implication is that the presence of NAFLD in patients with [type 2 diabetes] should alert the health care provider to institute a more aggressive lifestyle intervention and consider strategies to minimise high cardiovascular risk.”

The study indicates that people with non-alcoholic fatty liver disease should carefully control their weight by eating a healthy diet and getting plenty of exercise on a regular basis. Cutting out cigarettes and alcohol can also prevent non-alcoholic fatty liver disease from getting worse.

The findings are published in the journal Diabetes Care.