The “Streetwalking Mom” and the Treatment of Fatty Liver
Recently, the story of an ordinary mother in Wuhan, Hubei province, who donated her liver to save her son in July, has touched the hearts of countless people. The mother, Chen Yurong, had a son with congenital liver insufficiency (hepatomegaly). In order to donate her son’s liver, Chen Yurong, who suffered from severe fatty liver, “walked” 10 kilometers every day and ate only half a fist-sized rice ball at each meal, but in seven months, her fatty liver miraculously disappeared. While the news caused a big stir on the Internet, many patients who also suffered from fatty liver wondered: Is fatty liver harmful or not? Why can’t fatty liver be used for liver transplantation? Is it true that daily “binge walking” and extreme dieting will definitely heal the fatty liver? The maternal glory and dedication shown by Ms. Chen is indeed touching, and from this extreme example, we can see that diet adjustment and exercise can indeed alleviate fatty liver, but I believe that patients with fatty liver should not simply copy the “binge walking + maximum diet” model, but should gradually make lifestyle adjustments under the guidance of a doctor, so as not to aggravate liver damage and prevent liver transplantation. However, I believe that patients with fatty liver should not simply copy the “binge walking + maximum dieting” model, but should make gradual lifestyle adjustments under the guidance of a doctor to avoid the possibility of increased liver damage and nutritional imbalance. Ma Xiong, Department of Gastroenterology, Shanghai Renji Hospital
With the change of people’s lifestyle and dietary habits in China, the incidence of non-alcoholic fatty liver disease (hereinafter referred to as fatty liver) is increasing year by year and has become one of the most common causes of chronic liver disease worldwide. Nearly 1/3 of adults in the United States have fatty liver, and the prevalence in China is over 15% of the general population. More worryingly, the prevalence of fatty liver disease is higher in people with obesity, diabetes, hypertension, hyperlipidemia and coronary heart disease, all of which are like “difficult brothers” in the medical term “metabolic syndrome”. Fatty liver disease includes simple hepatic steatosis, non-alcoholic steatohepatitis and liver cirrhosis. Among them, simple hepatic steatosis has a good prognosis, but this is when the liver is in a “subhealthy” state and is more susceptible to liver-damaging factors such as alcohol, drugs and ischemia than a normal liver. A liver with severe fatty liver, such as Chen Yurong’s, is more susceptible to ischemic damage to the transplanted liver if used for a liver transplant. In layman’s terms, this means that the liver does not function as it should in the recipient’s body, leading to a failed operation. In turn, patients with moderate to severe fatty liver who donate their livers are at a much higher risk of liver failure after surgery because their remaining livers are not able to handle the “workload”. About 10% of simple steatosis will progress to the steatohepatitis stage. The course of nonalcoholic steatohepatitis is the same as that of other viral hepatitis, with 20% to 40% of patients with nonalcoholic steatohepatitis progressing to hepatic fibrosis and cirrhosis. We do encounter many patients with fatty liver causing liver fibrosis in our clinical work. It is now believed that the majority of patients with previously thought unexplained cirrhosis are caused by steatohepatitis.
Diagnostic criteria for fatty liver include: no history of alcohol consumption or alcohol consumption equivalent to <140 grams of ethanol per week in men and <70 grams per week in women; exclusion of specific diseases that can lead to fatty liver such as viral hepatitis, drug-related liver disease, total parenteral nutrition, hepatomegaly, etc.; in addition to clinical manifestations of the primary disease, non-specific symptoms and signs such as malaise, dyspepsia, vague pain in the liver area, hepatosplenomegaly, etc.; overweight and/or central There may be overweight and/or central obesity, increased fasting glucose, dyslipidemia, hypertension and other metabolic syndrome-related components. Serum aminotransferase and glutamyl transpeptidase levels may be mildly to moderately elevated (less than 5 times the upper limit of normal), usually dominated by elevated alanine aminotransferase (commonly known as "GPT" in the past); liver imaging is consistent with the diagnostic imaging criteria for diffuse fatty liver; histological changes on liver biopsy are consistent with the pathological The diagnostic criteria were met. Here it is worth mentioning the calculation method and determination criteria of BMI (i.e. body mass index), BMI = weight (kg)/[height (m)]2. For Asian adults, BMI≥23kg/m2 indicates overweight, BMI≥25kg/m2 indicates mild obesity, and BMI≥30kg/m2 indicates severe obesity. Central obesity refers to: waist circumference ≥ 90 cm for men and ≥ 80 cm for women.
Clarification of the presence of liver fibrosis in patients with fatty liver is a prerequisite for anti-fibrotic treatment. When various symptoms of cirrhotic decompensation (e.g., ascites, ruptured esophageal varices bleeding, hypersplenism, etc.) have not yet appeared, liver puncture biopsy is usually used clinically as the main criterion to determine the presence of liver fibrosis in patients, and Chen Yurong was diagnosed with severe fatty liver through this test. However, due to the possible complications of liver puncture and its invasive operation, it is usually not the preferred diagnostic method for patients. On the contrary, liver ultrasound has an important diagnostic value in daily clinical work because of its non-invasive, painless, economical and reproducible advantages.
Comprehensive treatment of fatty liver is emphasized, and patients must make lifestyle changes, diet, exercise, abstain from alcohol and smoking, as well as control primary diseases (e.g., hypertension, diabetes and hyperlipidemia). For high-risk groups who do not recover sufficiently after adequate lifestyle treatment or who have combined cardiovascular disease, treatment with medications is required, including lipid regulation, blood pressure lowering and improvement of insulin resistance and blood glucose control. Therefore, the treatment of fatty liver can be commonly summarized as “eat less, move more”.
“Eat less” means nutritional therapy. In fact, eating only half a fist-sized rice ball at each meal, as Chen Yurong did, is not in line with the principles of nutritional therapy. According to the patient’s ideal body weight, appropriate amount of calories should be given, the proportion of the three major energy-creating nutrients should be reasonably distributed, vitamins, minerals and dietary fiber should be appropriately supplemented, and bad eating habits should be changed. On the basis of controlling the total energy intake, the ratio of the three major energy-producing nutrients should be reasonably adjusted, i.e., the percentages of carbohydrate, fat and protein in the total caloric energy should be 45%-55%, 25-30% and 15-25% respectively. Regular three meals a day should be implemented, avoiding overeating and late night snacking, and reducing fast food and snacking. Irregular diet, such as often skip breakfast, or uneven distribution of the three meals can disrupt the metabolism of substances in the body. Reasonable meal energy distribution for the morning: in: evening = 25%: 40%: 35%. The people often say “breakfast eat well, eat a full meal, dinner eat less” or have some truth to it. Here we should pay attention to is that each meal so that they have “seven minutes full” can be. At the same time, you can increase the intake of vegetables, fruits, nuts and olive oil in your diet. Excessive salt intake can cause thirst and stimulate appetite and increase weight, so experts recommend that the daily intake should be less than 6 grams. In addition, drinking tea has a variety of functions such as reducing weight and body fat storage, reducing fatty acid synthesis in the liver, antioxidant and so on, and therefore can be applied to the treatment of fatty liver.
Some patients who also suffer from cardiovascular disease may have the habit of drinking small amounts of red wine to improve microcirculation. They may have questions about the “no alcohol” treatment principle for fatty liver, should they also give up red wine? In fact, you can rest assured that recent foreign studies suggest that drinking a small amount of red wine daily has little or no effect on the treatment of fatty liver, and is even beneficial.
“More movement” refers to how scientific and reasonable standardized exercise therapy. Reasonable exercise helps to promote fat metabolism. Insufficient exercise can aggravate the development of fatty liver, and even affect liver function in serious cases; excessive exercise can cause fatigue and aggravate the condition, which is not good for further treatment.
Choose the appropriate exercise program, scientific training, in order to play the beneficial effects of exercise on the human body. Some patients with fatty liver believe that they can “get rid of the disease” by taking the pills prescribed by the doctor on time, and they insist on dieting and exercising intermittently. It is not known that diet and exercise prescriptions are as important as drug prescriptions in the treatment of fatty liver.
There are many types of exercise therapy, among which aerobic training is more suitable for fatty liver treatment. Exercise prescriptions must be individualized, as each person’s lifestyle, work characteristics, basic conditions and current liver function are different, and therefore exercise programs vary. For middle-aged and elderly patients, exercises with low intensity and low heart rate variation, such as walking, jogging, swimming, cycling, etc., are appropriate; for younger patients with fatty liver, activities with higher intensity and heart rate variation, such as dancing and games, can be performed according to their own interests. The daily exercise time is better to be performed 1 hour apart after dinner. To eliminate excess fat, each session of aerobic exercise must last at least half an hour, before which sugar is often consumed rather than fat. The frequency of exercise depends on the intensity of the exercise and the duration of each exercise. Depending on need and functional status, 3 to 7 times per week. Daily exercise can produce a better training effect. Do not “fish for three days, sunbathe for two days”. It is generally considered appropriate to lose about 1 kg per week, because the main component of weight loss in rapid weight loss is water rather than fat. And rapid weight loss in a short period of time has the risk of further aggravating liver damage. The rate of progression of exercise can be divided into three phases: (1) the beginning phase: should include stretching gymnastics and low-intensity aerobic exercise, these activities are less likely to cause injury and muscle soreness. The duration of exercise in the beginning phase is at least 10 to 15 minutes, then gradually increase, and this phase lasts 4 to 6 weeks; (2) improvement phase: different from the beginning phase, participants can progress faster. Exercise intensity gradually increases to 60% to 80% of the maximum functional level in 2 to 3 weeks; (3) maintenance phase: often begins after 8 months of exercise training, in which the participants’ cardiopulmonary function reaches a satisfactory level and are not interested in continuing to increase the exercise load, requiring the exercise load to remain constant and maintain a healthy state. In addition to walking and jogging, different kinds of activities of interest should be added, which can avoid interruption of exercise due to tedious repetitive activities. The following points should be noted when implementing exercise therapy: (1) it must be carried out on the basis of strict dietary control to achieve the best exercise efficacy; (2) there should be preparatory exercises before and after exercise therapy, and relaxation exercises after exercise. to avoid cardiovascular accidents or muscle damage; (3) the guidance of exercise therapy is better to individual education guidance, according to each person’s condition and physical strength, guide the patient to gradually transition from lower intensity exercise to larger intensity exercise; (4) for patients with existing liver function impairment, the initial exercise should not be too much, should be reduced by 10-20% of the regular exercise, but the duration of exercise can be slightly extended. In fact, Chen Yurong took 10 kilometers of walking exercise per day at the beginning, which in the doctor’s opinion was still a bit too hasty.
The key to successful treatment of fatty liver is the collaboration of the patient, health care providers and family members. Patients are advised to keep a detailed record of their daily dietary intake, dietary structure ratios, cooking methods, and exercise through a diet and exercise diary, which will help to improve the efficacy of treatment by making continuous corrections during subsequent follow-up visits.
For those who do not improve significantly after 3 to 6 months of basic treatment such as treating the cause or removing predisposing factors (e.g., controlling blood sugar in diabetics, quitting alcohol in severe alcoholics, losing weight in obese people, etc.), controlling diet, and increasing exercise, lipid regulation (e.g., statins, levocannabinoids) and weight loss drugs (orlistat, sibutramine) can be administered under the guidance of a doctor. Patients who already have obvious impairment of liver function can be treated with liver-protective therapy (e.g., ezetimibe, vitamin E, Eusebio, etc.) to reduce the degree of liver inflammation and necrosis, stop the progression of liver disease, and avoid the occurrence of cirrhosis.
In conclusion, the key to the treatment of fatty liver is to actively remove the causes and predisposing factors, such as obesity, diabetes, alcoholism, etc.; secondly, adjust the diet structure and correct the nutritional imbalance; thirdly, emphasize exercise and choose an aerobic metabolic exercise program. During exercise training, attention should also be paid to the coordination of exercise with diet and drugs, both to control a reasonable diet and not lack of nutrition. Try to achieve the most effective treatment effect with the minimum amount of chemical means and maximum physiological measures.
The great mother Chen Yurong, who moved countless of us, said when she was reviewed by the hospital after seven months of difficult diet and exercise: My son will be as healthy as you are. My son has been sick for 18 years, I want to give him a liver. As long as I take one more step and eat one less bite, I will be closer to the day I save my son. If I can’t donate yet this time, I will keep going. This spirit of Chen Yurong deserves recognition, but her eager approach is actually further debatable. It is recommended that the majority of fatty liver patients should not simply copy Chen Yurong’s model of “binge walking + extreme dieting”, but should learn from her spirit of perseverance, under the guidance of doctors, scientific and reasonable, gradual and regular treatment.