Scientists have found that individuals with fatty liver were five times more likely to develop Type 2 diabetes than those without fatty liver.
This higher risk seemed to occur regardless of the patient's fasting insulin levels, which were used as a marker of insulin resistance.
The study has shown that fatty liver may be more than an indicator of obesity but may actually have an independent role in the development of Type 2 diabetes.
"Many patients and practitioners view fat in the liver as just 'fat in the liver,' but we believe that a diagnosis of fatty liver should raise an alarm for impending type 2 diabetes," said senior author Sun Kim of Stanford University in California.
"Our study shows that fatty liver, as diagnosed by ultrasound, strongly predicts the development of type 2 diabetes regardless of insulin concentration," said Kim.
For the study, researchers examined 11,091 Koreans who had a medical evaluation including fasting insulin concentration and abdominal ultrasound at baseline and had a follow-up after five years.
Regardless of baseline insulin concentration, individuals with fatty liver had significantly more metabolic abnormalities including higher glucose and triglyceride concentration and lower high-density lipoprotein cholesterol concentration.
Individuals with fatty liver also had a significantly increased risk for type 2 diabetes compare to those without fatty liver.
"Our study shows in a large population of relatively healthy individuals that identifying fatty liver by ultrasound predicts the development of type 2 diabetes in five years.
"In addition, our findings reveal a complex relationship between baseline fatty liver and fasting insulin concentration," added Kim.
The study will be published in the Endocrine Society's Journal of Clinical Endocrinology and Metabolism.