How to prevent and treat fatty liver
(A) Pathogenesis
The etiology of fatty liver includes two aspects: the conditions for the development of fatty liver (causative factors) and the causes of fatty liver (pathogenic factors).
The pathogenic factors of fatty liver include chemical factors, nutritional factors, endocrine metabolic factors, biological pathogenic factors, genetic factors, etc.
1, chemical pathogenic factors, including chemical toxins (yellow phosphorus, arsenic, lead, benzene, carbon tetrachloride, chloroform, etc.) drugs (methotrexate, tetracycline, amiodarone, glucocorticoids, etc.) alcohol and other alcohol addiction has been the most common cause of fatty liver and cirrhosis in Europe and the United States;
2, nutritional factors overweight diet caused by obesity is one of the most common factors causing fatty liver in recent years protein and calorie deficiency is another important cause of fatty liver
3, biological factors, including viruses and bacteria and other pathogenic microorganisms and parasites, these pathogenic factors mainly cause hepatocyte degeneration necrosis and inflammatory cell infiltration Recent studies have found that some hepatitis C virus and hepatitis D virus infection can cause large vesicular and small vesicular hepatocellular steatosis respectively tuberculosis sepsis and some chronic bacterial infectious diseases can also be caused by malnutrition, hypoxia and cytotoxic damage and other factors Hepatocellular steatosis in addition to the recovery period of various types of viral hepatitis and chronic viral infections can induce obesity fatty liver
4, genetic factors mainly through the genetic material gene mutation or chromosome aberration directly cause disease in the liver they mainly cause congenital metabolic liver disease which hepatomegaly galactosemia glycogen accumulation disease fructose intolerance and other genetic diseases can cause large vesicular fatty liver and urea cycle enzyme congenital defects mitochondrial fatty acid oxidation genetic defects and so on can cause small vesicular fatty liver in addition to certain families In addition, some people in certain families have certain disease qualities such as obesity, type I diabetes, primary hyperlipidemia, etc. This phenomenon is called genetic susceptibility.
How to prevent fatty liver?
1, a reasonable diet three meals a day should be reasonable to make a rough and fine nutritional balance a sufficient amount of protein can remove fat in the liver
2, appropriate exercise every day to adhere to physical exercise can be their own physical fitness to choose the appropriate sports such as jogging playing table tennis badminton and other sports; to start with a small amount of exercise gradually and gradually reach the appropriate amount of exercise to strengthen the body fat consumption
3, careful use of drugs liver is the body’s chemical plant any drugs into the body are to be detoxified by the liver, so usually do not move to take drugs, especially do not just eat the so-called health care drugs advertised on the appearance of symptoms of fatty liver patients in the choice of drugs should be more careful to prevent the toxic side effects of drugs, especially on the liver damage drugs should never be used to avoid further aggravation of liver damage
4, in addition, the mood should be cheerful not angry less irritated pay attention to the combination of work and rest is also very important
How should fatty liver be treated?
(A) Treatment
1.Treatment principles of fatty liver Fatty liver is not only a reversible disease but also a pathological manifestation of systemic diseases in the liver, such as early detection of the cause of the disease and timely comprehensive treatment of intrahepatic lesions before further evolution into cirrhosis can still be reversed The treatment principles of fatty liver can be summarized as follows
(1) Remove the causes and predisposing factors and actively control the primary disease
(2) Adjust the diet to correct nutritional imbalance
(3) Adhere to the necessary exercise to maintain the ideal weight
(4) Maintain relatively normal blood lipid and blood glucose levels
(5) Education of self-care awareness to correct malpractice
(6) Appropriate supplementation with hepatoprotective and anti-liver fibrosis drugs to promote the excretion of lipids in the liver to prevent liver cell necrosis and inflammation and fibrosis, if necessary
2, remove the cause of fatty liver is a multi-causal acquired disease to find and remove the cause and actively control the primary disease is vital to the prevention and treatment of fatty liver mild or moderate fatty liver in the removal of the cause and control the primary disease liver histological changes can be improved or even completely back to normal most drug fatty liver in a timely manner after the discontinuation of drugs within 2 to 3 months can be completely normal due to long-term alcoholism alcoholism. Alcoholic fatty liver patients should abstain from alcohol and alcoholic fatty liver is absolutely effective for simple alcoholic fatty liver; fatty liver deposits in the liver are usually completely eliminated within weeks or months of abstinence from alcohol; malnutrition fatty liver patients should be reasonably well nourished; fatty liver due to small intestine diversion surgery should be re-surgically anastomosed to restore the intestinal canal to the condition before diversion and supplemented with essential amino acids; obesity and diabetic fatty liver treatment is the key to effective weight control Fatty liver caused by parenteral nutrition should avoid excessive calorie and fat emulsion infusion and early opening of oral or tube feeding diet as much as possible; chronic hepatitis patients, regardless of whether the disease requires long-term excessive calorie intake and overemphasis on rest, can induce fatty liver due to weight gain, so these factors should be avoided as much as possible; fatty liver caused by pregnancy vomiting disappears after supplementation, while acute fatty liver during pregnancy disappears after supplementation. Fatty liver can be completely eliminated after termination of pregnancy and control of complications, and no sequelae will remain.
3.Rational diet The principles of fatty liver diet therapy are mainly appropriate caloric intake, rational distribution of the three major nutritional elements and taking into account their quality, appropriate supplementation of vitamins, minerals and dietary fiber, alcohol cessation and change of bad eating habits, diet adjustment is the basic method of treatment of most chronic fatty liver and an important measure to prevent and control the progress of fatty liver. A diet rich in lipophilic substances such as lean meat, fish, egg whites and fresh vegetables can help to promote the elimination of fat in the liver. High-fiber foods can help to increase satiety and control blood sugar and blood lipids, which is especially important for over-nourished fatty liver. Fat intake is necessary for human health, even if you consume fat-free food, the body can still use sugar and amino acid predecessors to synthesize fat; while excessive intake of sugar, especially sweet foods rich in monosaccharides or disaccharides, can increase the secretion of insulin and promote the conversion of sugar into fat. Inadequate protein intake can aggravate fat deposition in the liver, while high protein diet can increase the synthesis of apolipoprotein, especially VLDL, which is conducive to the smooth transport of lipids out of the liver to reduce fatty liver and facilitate the recovery and regeneration of liver cell function. Fatty liver and kidney disease patients should not have too much protein intake. In short, according to the different causes and conditions of patients to develop different dietary treatment plans and timely adjustment when the condition changes
4, exercise therapy for obesity diabetes hyperlipidemia caused by steatohepatitis patients can be completed under the guidance of a doctor moderate amount of exercise that is about 50% of the maximum intensity so that the heart rate reaches a certain standard (20-30 years old 130 times / min; 40-50 years old 120 times / min; 60-70 years old 110 times / min) each lasted 10-30min more than 3 times a week for obese people Exercise therapy is more important than dieting alone to lose weight, the reason is that exercise to lose weight is mainly abdominal visceral fat often can cause triacylglycerol low-density lipoprotein (LDL) decline and high-density lipoprotein (HDL) rise glucose tolerance improvement and blood pressure drop daily exercise caloric consumption 1260kJ 4 months can lose 4, 5kg
5, lipid elimination drugs Drug therapy is of positive significance in promoting the regression of intrahepatic fat and its accompanying inflammation as well as stopping its development towards liver fibrosis and cirrhosis, however, there are still no effective drugs to prevent and treat steatohepatitis. Existing lipid elimination and liver-protective drugs are mainly used as adjuvant therapy for patients with non-alcoholic steatohepatitis and alcoholic liver disease with liver function impairment and (or) obvious symptoms. Methionine and some B vitamins
(1) Choline: Choline is a component of lecithin, the predecessor of phosphorylcholine, and plays an important role in promoting phospholipid synthesis, accelerating intrahepatic fat transport and lipoprotein production. These drugs are suitable for protein-calorie deficiency or malignant malnutrition, as well as for those who receive long-term parenteral intravenous high-energy nutritional therapy, and are not effective for other types of fatty liver.
(2) Methionine: Methionine is an essential amino acid that provides methyl synthesis of choline in the body and plays an important role in the maintenance of phospholipid metabolism and the structural and functional integrity of biological membranes, thus promoting intrahepatic fat metabolism and hepatoprotective detoxification. If methionine is supplemented promptly, liver pathology is rapidly reversed. However, excessive supplementation of methionine may lead to hypermethionemia and increase the risk of hepatic encephalopathy. Inadequate liver function and hepatic encephalopathy is prohibited
(3) Vitamin: Vitamin BCE is involved in liver fat metabolism in the body and has a certain protective effect on liver cells. B vitamins have a protective effect on hepatocytes by turning pantothenic acid into coenzyme A in tissues; coenzyme A is required for many reactions in the body (including fatty acid oxidation and synthesis); biotin is a component of the carboxylase enzyme necessary for fat-protein sugar metabolism; pyridoxine prevents and reduces the cytotoxic nicotinamide produced by the combination of the ethanol metabolite acetyl with amines in hepatocytes Vitamin B12, folic acid and other vitamins also play an important role in lipid metabolism in the body, but improper supplementation of vitamins is very likely to produce toxic reactions and no clinical reports have been found so far on the efficacy of vitamin BE in the prevention and treatment of fatty liver, so for patients with fatty liver supplementation should be carefully selected for its dosage form and short duration of treatment with appropriate doses of vitamin B6, B12, folic acid and compound preparations (complex). Vitamin B tablets) Vitamin CE may be beneficial in regulating protein and lipid metabolism
(4) Amino acid preparations: Protein is the basic building block of various tissues in the body and plays an important role in maintaining and restoring liver function, promoting tissue repair and synthesis of various immunoglobulinases. Exogenous amino acids to provide the body with protein consumed by metabolism amino acid preparations are mainly used in the treatment of malignant malnutrition and fatty liver caused by protein-calorie malnutrition For alcoholic fatty liver with a lean body type, especially with low plasma protein, additional amino acid supplementation is also required
(5) Carnitine orotate: Carnitine is a nutrient necessary for energy metabolism in the body and plays an important biological role in fat metabolism. Carnitine in the body is mainly derived from food and can also be synthesized by the liver through amino acids in food. It can normalize the enzymatic system of DNA and protein synthesis in damaged cells, thus preventing necrosis and promoting cell repair and regeneration. The presence of carnosine and orotate in the form of salt greatly enhances the solubility and absorption of orotate in the body, which in turn promotes the anti-lipid effect of carnosine. Liver function and clinical symptoms
(6) Ursodeoxycholic acid: it is widely used in the prevention and treatment of cholesterol stones, cholestasis and other biliary diseases. Ursodeoxycholic acid protects hepatocyte membranes; increases the secretion of endogenous bile acids and reduces their reabsorption; protects mitochondria; inhibits apoptosis; regulates immunity; and affects intracellular signaling. The recommended dose: 8-15 mg/kg per day in 3 oral doses for 3 months as a course of treatment, often requiring more than six months of treatment.
(7) Antioxidants: Among the cytoprotective drugs antioxidants can inhibit the lipid peroxidation of oxygen radicals currently have been used in experimental animals and human alcoholic liver disease and part of the treatment of non-alcoholic fatty liver animal experimental studies have shown that taurine can significantly reduce lipid liver function and the degree of fatty liver in high-fat diet + alcohol rats, but there is no significant improvement in alcoholic liver fibrosis reduced glutathione (GSH) GSH is used as a physiological factor in the treatment of various acute and chronic liver diseases, including fatty liver, steatohepatitis and toxic liver damage.
(8) Lecithin: Essential phospholipid (Essential) is a phospholipid extracted from soybeans, the main component of which is diacylphosphatidylcholine. Its chemical structure is the same as that of endogenous phospholipids, but it is functionally superior to the latter because it contains essential polyvalent unsaturated fatty acids (linoleic acid linolenic acid and oleic acid). The main protective effects of Essential on hepatocytes are.
①Protection and repair of damaged hepatocytes by a possible mechanism of reducing free radical attack and reducing lipid peroxidation damage
②Reducing hepatocyte steatosis and necrosisEssential can convert various neutral fats and cholesterol into metastable forms and allow for oxidation, so it has lipid removal effects
③Promote hepatocyte regeneration
④Reduces potential antigen- and antibody-dependent cell-mediated cytotoxicity (ADCC) and mitogen-mediated lymphocytotoxicity (MILT) by maintaining cell membrane stability, thereby inhibiting inflammatory infiltration and fibrous tissue proliferation
(5) Improvement of lipid metabolism in blood and liver
(9) Lipid-lowering drugs: Patients with fatty liver should weigh the pros and cons and carefully consider whether they need to use lipid-lowering drugs because some lipid-lowering drugs can effectively reduce serum lipid levels but cannot well remove fat deposits in the liver and have certain hepatotoxicity when used in large doses over a long period of time; therefore, in principle, lipid-lowering drugs are not needed for patients with fatty liver without hyperlipidemia; for alcoholic fatty liver with mild to moderate For alcoholic fatty liver with mild to moderate hyperlipidemia, complete abstinence from alcohol is the best treatment measure and generally no additional lipid-lowering drugs are needed; for obesity diabetes-related fatty liver with hyperlipidemia, after 3 months of treatment of the primary disease and control of diet and exercise, if plasma total cholesterol is still greater than 6,46 mmol/L or LDL cholesterol is greater than 4,13 mmol/L or triacylglycerol is greater than 2,26 mmol/L, the patient should For the treatment of fatty liver caused by primary hyperlipidemia, a comprehensive approach should be taken to reduce the mental burden, increase exercise and diet before considering the use of lipid-lowering drugs. Treatment