Q: I found fatty liver for 3 years in physical examination, transaminases have been normal, usually do not feel any discomfort, I heard many people say fatty liver as long as transaminases are not high does not matter, is this so? A: Fatty liver is often accompanied by obesity, diabetes, hyperlipidemia, etc. It is a metabolic disease and is a manifestation of metabolic syndrome in the liver. Clinically, fatty liver is often divided into simple fatty liver, steatohepatitis and liver cirrhosis. Most patients with simple fatty liver have normal transaminases, but a small number of patients can have abnormal transaminases; most patients with steatohepatitis have elevated transaminases, but a small number of patients can also have normal transaminases. There is no significant correlation between the level of transaminases and the degree of inflammation and fibrosis in liver histology, i.e. a low level of transaminases does not mean that the degree of inflammation and fibrosis in liver histology is mild. What’s more, the discovery of a fatty liver usually means that something is wrong with the body’s metabolism, and even if the transaminases are normal, regular monitoring of metabolism-related indicators, such as blood lipids, blood glucose and uric acid, is required. Therefore, it is recommended that you visit the hospital regularly to monitor the progress of your liver and other components of the metabolic syndrome and to develop a reasonable treatment plan. Yimin Mao, Department of Gastroenterology, Shanghai Renji Hospital Q: My husband suffers from fatty liver and I advised him to go to the hospital, but he said that fatty liver is just a little bit more fat in the liver and it doesn’t matter. I have also consulted other people and they all said that as long as the transaminases are normal, there is no harm to the body. Is fatty liver harmful to the body? A: The harmfulness of fatty liver should be understood from two aspects. On the one hand, the harm to the liver, fatty liver can cause liver damage, inflammation, liver fibrosis, about 25-35% of fatty liver patients can be accompanied by the progress of fibrosis, steatohepatitis, 9-20% of steatohepatitis can progress to cirrhosis, fatty liver is the most important cause of cryptogenic cirrhosis; moreover, there are Studies have shown that fatty liver is also related to the occurrence of liver cancer; fatty liver patients are more vulnerable to other liver-damaging factors than normal people, i.e., they are more likely to get other liver diseases, and it is more difficult to treat other liver diseases. On the other hand, since fatty liver is part of the metabolic syndrome, often accompanied by obesity, diabetes, hyperlipidemia, gout, etc. Moreover, fatty liver is closely related to arteriosclerosis, therefore, for the whole body, the danger of fatty liver is to increase the incidence of cardiovascular and cerebrovascular events, and after 10 years and 20 years, cardiovascular and cerebrovascular diseases can increase 3-5 times in people with fatty liver, which is even more harmful than to the liver itself. This is even worse than the damage to the liver itself, which comes earlier. Some studies have shown that fatty liver can shorten the life expectancy of patients under 50 years old by 4 years, and 10 years for those over 50 years old. Q: I have found fatty liver for 5 years, and recently ultrasound examination said it is severe fatty liver, I am 176 cm tall and weigh 110 kg, I heard people say that the faster I lose weight, the faster my fatty liver will improve, right? A: For obese fatty liver patients, weight loss and weight reduction are the main measures to treat fatty liver. A reasonable weight loss goal is 10% weight loss in 6 months, with a reasonable weight loss rate of 0.45-0.9kg/week, through diet control, increased exercise, correction of poor lifestyle, and reasonable application of weight loss drugs. In this way, after weight loss, fat deposits in the liver can be reduced or subside and liver function damage is restored. However, if the rate of weight loss is too fast, with weight loss exceeding 1.5 kg/week or 5
kg/month, it can intensify inflammation and fibrosis in the liver, worsen liver function, and increase the incidence of gallstones. Therefore, unscientific weight loss and too rapid weight loss are harmful to the body. Q: My father has fatty liver and high blood cholesterol, and my recent examination also found fatty liver, is this disease hereditary? A: Fatty liver itself is not a genetic disease, but is associated with a genetic background, medically known as genetic susceptibility, which refers to the predisposition to a certain type of disease that can be acquired by genetic qualities. There are genes related to genetic susceptibility for alcohol tolerance, obesity, type II diabetes, and abnormal fat metabolism in humans. Hypertension, hyperlipidemia, diabetes, obesity and other metabolic syndromes associated with fatty liver have a genetic predisposition, so people with these genetic backgrounds coupled with a poor lifestyle are more likely to get fatty liver. Q: I heard that fatty liver and diabetes are related, I found fatty liver 7 years ago, my blood sugar has been below 5 in annual physical examination, last month’s examination blood sugar 5.8, I am worried, will I get diabetes? A: Both fatty liver and diabetes are metabolic diseases. The main mechanism of fatty liver pathogenesis is insulin resistance, and insulin is the body’s main hormone to regulate blood sugar, therefore, the two diseases are closely related. It is also true that the incidence of fatty liver is observed to be high among diabetic patients in clinical practice, and likewise, many patients with fatty liver eventually progress to diabetes. Although your fasting blood sugar is currently normal, it is close to the upper limit. It is recommended that you go to the hospital for a glucose tolerance test to find out whether your postprandial glucose metabolism is normal, and at the same time, it is recommended that a simultaneous insulin measurement be made to fully assess your glucose metabolism status.