Stephen Goldfinger, M.D., is a professor of medicine at Harvard Medical School. He is a graduate of Columbia College of Physicians and Surgeons, and his clinical base is at the Massachusetts General Hospital.

Question:

Two years ago I was told I had a fatty liver. Now, I have high blood glucose levels (146 non-fasting). Could the two be related?

Answer:

Yes, they can be related. During the past decade, doctors have increasingly recognized fatty liver unrelated to alcohol use as a major cause of liver disease. The term to describe what some consider a growing epidemic is non-alcoholic fatty liver disease. Most often the accumulation of fat in the liver occurs without symptoms or adverse consequences.

Sometimes the fat causes liver inflammation, known as non-alcoholic steato-hepatitis. (Steato means fat.) In a very small minority of cases, the inflammation may lead to scarring, cirrhosis and even liver cancer.

One of the hallmarks of fatty liver disease is resistance to the sugar-lowering effect of insulin, which also is the cause of type 2 diabetes. This usually occurs in the obese. Obesity is a major factor contributing to non-alcoholic fatty liver disease. Indeed, the increasing obesity rate in our country is generally cited as the most important reason for the non-alcoholic fatty liver disease epidemic.

Fatty liver is not only associated with diabetes. It is now being recognized as frequently accompanying "metabolic syndrome," a worrisome collection of conditions that includes high blood pressure, abdominal obesity, elevated blood triglycerides and low HDL cholesterol (dyslipidemia) and high blood sugars.

Complications of metabolic syndrome include those related to cardiovascular disease (heart attacks, stroke, peripheral vascular disease) and diabetes (loss of vision, nerve damage, kidney failure). I do not know whether you have full metabolic syndrome, and hope you do not. I would make a strong guess that your doctor is encouraging you to lose weight to help treat the two problems you describe.