It's simple, the link between insulin resistance and fatty liver is your liver! The liver is both an organ and a gland with hundreds of jobs to do inside your body. And if you're Hispanic or Latino, understanding how insulin links to fatty liver is important.
In the U.S., about 41 Hispanics out of 100 have metabolic dysfunction-associated steatotic liver disease (MASLD). It's a liver condition where your body can't use or store energy normally, also called a “metabolic dysfunction.”
MASLD causes extra fat to build up in your liver, but not because of alcohol. They used to call it non-alcoholic fatty liver disease, but doctors now call the condition MASLD.
It's a balance
Your liver helps balance your body's energy storage to use later. It stores fats and blood sugar (glucose) as glycogen to balance your metabolism --- how your body gets energy. If your metabolism gets out of balance, insulin resistance and fatty liver can happen.
Normally, your body fat stays balanced with insulin. It's a hormone that controls blood sugar and is closely tied to MASLD. If your body makes too much insulin, you can get insulin resistance which can inflame your liver to cause MASLD.
In fact, people with prediabetes are 2.5 times more likely to have metabolic dysfunction-associated steatotic liver disease.
If the fats in your body get too high, fat gets stored in your liver to cause fatty liver (MASLD) which can also lead to insulin resistance. It's a two-way street where your liver gets out of balance.
In fact, fatty liver often causes insulin resistance, says Eric Thompson, MD, a gastroenterologist and hepatologist at Charlotte Digestive Health Associates in North Carolina.
Learn more about the link between insulin resistance and fatty liver, how higher insulin levels link to other medical conditions, and why Hispanics have a higher risk for MASLD in the U.S.
Insulin Resistance Starts Quietly
You can have insulin resistance for years without any symptoms. That's because higher sugar and fat levels can slowly unbalance your metabolism. Higher amounts of insulin in your bloodstream over time means your body can't respond to the hormone normally.
Your body can't move or store sugar normally
With insulin resistance, your cells can't move sugar from your blood into your muscle or liver cells for energy like normal. Instead, the extra sugar lingers in your bloodstream. And the extra blood sugar triggers your pancreas to make even more insulin, to lower your blood sugar levels.
Because your cells can't move the glucose normally, your insulin levels continue to rise. Slowly, over time, you can get insulin resistance.
“Insulin resistance simply means that your body needs a higher level of insulin to achieve the desired effect,” says Thompson. “In other words, your body keeps demanding more insulin just to keep blood sugar under control.”
Metabolic problems linked to insulin resistance
The condition is tied to metabolic problems because you can't use energy normally. So insulin resistance is also strongly linked to:
Weight gain
Fat buildup in your liver
Obesity
Prediabetes
Type 2 diabetes
Heart disease
The Visceral Fat, Insulin Resistance, and Fatty Liver Cycle
Too much fat around your organs can trigger insulin resistance, and fatty liver. It's a metabolic loop where your body changes glucose into fat:
The loop can start with your liver having too much glycogen --- how glucose is stored in your liver.
After a sugary meal, the extra glucose is changed into fat because your liver is already full of glycogen (stored glucose).
The extra glucose gets stored inside your liver as fat.
Slowly, over time, too much fat gets stored in your liver and leads to liver disease.
The extra fat causes inflammation, swelling, and other problems to make insulin resistance worse.
That's because not all body fat is created equal. There are two main types of body fat:
Subcutaneous fat lies just under your skin and is the softness you might feel when you poke your belly.
Visceral fat is stored inside and wraps around your organs, like your liver, and is metabolically active.
Visceral fat blocks insulin signaling
Too much visceral fat around your organs can cause inflammation and may be harmful because the fat cells can make:
Hormones that block insulin
Inflammatory molecules that impact your health
“[Viceral] fat produces hormones that interfere with insulin signaling,” says Thompson. These inflammatory chemicals make it harder for insulin to do its job, making insulin resistance worse.
The inflammatory chemicals made by visceral fat can make cells more resistant to insulin signals. As this type of fat builds up in your liver, insulin resistance occurs.
The pancreas works overtime
To overcome your muscle and liver cell resistance to insulin, your pancreas pumps out more insulin. This extra insulin (hyperinsulinemia) may keep blood sugar stable for a short while. But excess insulin also signals your liver to store energy (sugars) as fat.
The liver turns sugar into fat
Higher insulin tells your liver to store extra glucose as energy and that often means fat. Even if you don’t eat much dietary fat, your higher insulin levels and liver fat can begin to cause inflammation.
Fat builds up in the liver
Higher amounts of fat cells inside your liver can make inflammatory molecules and more hormones that block how insulin works. Over time the extra liver fat can cause MASLD.
Communities at Highest Risk for MASLD
Hispanics and Latinos in the U.S. have a higher risk for fatty liver disease because of genetics, diet, and socioeconomic factors.Experts are still figuring out the exact cause, but the higher MASLD risk may be a combination of genetics, diet, and environment.
Genes for MASLD
Because genes and shared lifestyle patterns run in families, multiple family members may deal with insulin resistance which can lead to MASLD.
Differences in two genes that control liver fat are more common in Hispanics and Latinos:
PNPLA3 gene can raise your liver fat.
GCKR gene also raises fat storage in your liver.
These genes can make it easier for visceral fat to build up around your liver no matter what your body weight is.
Some studies suggest that Hispanics may store more fat around their abdominal organs, too. And that can raise your insulin resistance risk, even if you have a lower BMI.
“Many different things can cause insulin resistance, but one very common cause is fat build up in the body,” says Thompson. “When fat gets stored in places it shouldn’t be — like the liver and other tissues, this gets in the way of your body’s ability to respond to insulin like it should.”
Diet factors
In the U.S., processed foods, fast foods, and frozen foods are highly marketed to Hispanics and Latinos. Although these foods may seem easy to make a quick meal, they contain high amounts of saturated fat and sugar.
While diet isn’t always the culprit for weight gain, a diet high in saturated fats and sugar can lead to insulin resistance and fatty liver.
That's because extra fat and sugar can cause your:
- Blood sugar to rapidly spike and raise your insulin levels.
- Liver to store fat which builds up over time, like extra sugar from processed, sugary drinks and foods.
- Visceral fat to get higher because calorie-dense foods lack nutrition, leading to overeating and weight gain.
The good news is that small, steady lifestyle changes can make a big difference. Eating fruits, vegetables, whole grains, and heart healthy fats is a great start to reach your target weight.
Socioeconomic factors
Access to affordable, healthy food can make shopping harder. You may be limited in time and energy when cooking for your family. And access to healthcare may prevent getting treatment for medical problems before they start.
This can make it harder to lower your risk for both insulin resistance and fatty liver.
But there are simple things that you can do, such as:
Stay active. Even going on a 10 minute family walk can keep you moving.
Add resistance training. Use exercise bands to build muscle and raise your metabolism.
Eat smaller portions. Cutting calories is a great way to reach your goal weight and lower liver fat.
Cut sugar. Try a small piece of fruit, drink plain or sparkling water instead of soda, or swap applesauce for desert.
Tips for Talking Prevention with Your Doctor
If you’ve been diagnosed with MASLD or insulin resistance, the next step is to prevent your condition from getting worse. You can take certain steps to protect your long-term health and your family.
And because many metabolic disorders are linked, treating one can help the other conditions, too.
That means treatments for your insulin resistance also benefit:
Fatty liver
Obesity
Diabetes
Your whole body
Related conditions
Fatty liver often overlaps with other medical conditions such as:
- Insulin resistance
- Diabetes
- Obesity
- Heart disease
Ask your doctor about getting screened for these other conditions. So if your doctor orders tests they can screen you for metabolic disorders at the same time.
Discuss family history
If you're Hispanic or Latino and metabolic disorders run in your family, bring it up with your doctor. You can also write down what you want to say ahead of time. This can help you remember what to say.
You'll want to tell your doctor about:
- Which family members have insulin resistance or diabetes
- If any family members have obesity or heart disease
- Which family members have fatty liver, and the type (MASLD or MASH)
- The ages each family member got diagnosed
- Any related conditions they may have such as obesity, heart disease, or cancers
Ask for practical tips
Instead of broad advice like “lose weight,” ask your doctor to help you make a detailed plan.
Ask about a treatment plan for:
- Weight loss, if you have overweight or obesity
- Insulin resistance, lowering your blood sugar, or treating diabetes
- MASLD including lifestyle changes and medications
You can also ask for referrals to dietitians, diabetes educators, and other specialists for help.
Ask about safe exercise options
Even moderate activity like walking can improve insulin sensitivity. If you’re not sure where to start, ask what types of exercises would be safe for you and how often to do them.
“Reducing excess weight helps your body respond to insulin more effectively, lowering the strain on your pancreas and liver,” says Thompson. "When you move toward a healthier diet and lose weight as a result, the first place that weight disappears from is your liver.”
Your doctor may also talk about next steps
Sometimes making changes to your diet and exercise isn't enough. There are medications to treat diabetes, obesity, and some types of fatty liver.
“Lifestyle changes are the first line of treatment,” says Thompson. “But for those that are unable to progress, anti-obesity medications can work and are becoming more widely used."
Treat many conditions at once
Luckily, many treatments and medications that work for obesity and diabetes also benefit fatty liver. "Bariatric surgery is also an option and has great benefits for those who need it,” says Thompson.
Using one medication to treat more than one metabolic disorder can help cut costs and mean taking fewer medicines. Talk with your doctor about the best option for your health.
