Gastroenterologists are often asked by patients with fatty liver reports, “Did I get fatty liver because I ate too much fat?” In fact, fatty liver is not the same as eating too much fat, and it is a common misconception that fatty liver is the same as excessive fat intake. Problems with any part of the fat metabolism process in liver cells, which are the key site of fat metabolism, can result in fat accumulation in liver cells, not just from excessive fat intake. These problems include: impairment of fatty acid catabolism and transfer, excessive fat synthesis, hepatocyte toxicity and malnutrition. Therefore, fatty liver is not necessarily caused by excessive fat intake.
What is fatty liver?
Fatty liver, is a lesion caused by excessive accumulation of fat in the liver cells due to various reasons. The liver is an important organ that metabolizes fat in the body. Fatty liver is formed when there is an excessive accumulation of fat in the liver cells due to various reasons.
What are the symptoms of fatty liver?
In the early stage, most patients with fatty liver do not have any symptoms. The most common symptom is weakness, but it is not proportional to the severity of the disease; some patients have atypical symptoms such as mild discomfort in the right upper abdomen, vague pain or epigastric distension. Patients with severe fatty liver may have symptoms such as itching of the skin, loss of appetite, nausea and vomiting. Patients who develop cirrhosis may develop serious complications such as ascites and bleeding. Half of the patients will develop an enlarged liver, which can be palpable in the upper right abdomen.
Why do you get fatty liver from drinking alcohol?
As the name implies, alcoholic fatty liver is associated with alcohol consumption, which is also metabolized in the liver. Long-term alcohol damage can lead to a decrease in the ability of liver cells to metabolize fat, which in turn leads to the accumulation of fat in the liver and the formation of a fatty liver. Liver puncture biopsies in chronic alcoholics show fatty infiltrates in 75% to 95%. It has also been observed that the incidence of alcoholic fatty liver increases by 5-25 times if more than 80-160 grams of alcohol is consumed daily.
What about non-alcoholic fatty liver?
Non-alcoholic fatty liver is a clinicopathological syndrome characterized by diffuse hepatocellular steatosis, except for alcohol and other clear liver-damaging factors, and can be divided into the following categories.
1, obese fatty liver: the degree of fat accumulation in the liver is proportional to body weight. 30%~50% of obesity combined with fatty liver, and the rate of fatty liver lesions in severely obese people is as high as 61%~94%. Obese people’s weight is controlled, its fat infiltration also reduces or disappears.
2, rapid weight loss fatty liver: fasting, excessive dieting or other rapid weight loss measures can cause a large increase in lipolysis in the short term, consuming glutathione (GSH) in the liver, causing a large increase in malondialdehyde and lipid peroxides in the liver, damaging liver cells and leading to fatty liver.
3, malnutrition fatty liver: malnutrition leading to protein deficiency is an important cause of fatty liver, mostly seen in insufficient food intake or digestive disorders, can not synthesize apolipoproteins, resulting in triglyceride accumulation in the liver, the formation of fatty liver.
4, diabetic fatty liver: about 50% of diabetic patients can occur fatty liver, which is more adult patients. Because adult diabetic patients with 50% to 80% are obese, their plasma insulin levels and plasma fatty acids increased, fatty liver change is related to both the degree of obesity, but also with the consumption of fat or sugar too much.
5, drug fatty liver: certain drugs or chemical toxins cause fatty liver by inhibiting protein synthesis, such as tetracycline, adrenocorticotropic hormone, puromycin, cyclamate and arsenic, lead, silver, mercury, etc.. Lipid-lowering drugs can also form fatty liver by interfering with the metabolism of lipoproteins.
6.Gestational fatty liver: Most of them develop at 34~40 weeks of gestation in the first child. In the late pregnancy, due to the abnormal increase of hormones, liver fat metabolism becomes impaired, causing rapid accumulation of fat in hepatocytes and other tissues and organs, resulting in swelling and steatosis of hepatocytes, and steatosis of kidney, pancreas, brain and bone marrow can also occur. Severe disease, poor prognosis, maternal and infant mortality rate of 80% and 70% respectively.
Fatty liver caused by other diseases: fatty liver can also occur during infections such as tuberculosis, bacterial pneumonia and sepsis, and fatty liver can easily accumulate in liver cells of patients with viral hepatitis who excessively restrict their activities and consume a high sugar and high calorie diet; fatty liver is more likely to occur after receiving corticosteroid treatment. Fatty liver improves rapidly after controlling the infection or removing the cause. There are also so-called extra-gastrointestinal hypertrophic fatty liver, toxic fatty liver, and fatty liver caused by hereditary diseases.
Who is prone to get fatty liver?
1, obesity: the degree of obesity and fatty liver and the incidence of steatohepatitis and its degree are significantly related. Sudden weight loss? 5 kg/month can mobilize adipose tissue free fatty acid into the liver, and stimulate the increase of insulin secretion, also prone to fatty liver and steatohepatitis. The literature reports that 52%~80% of obese patients suffer from fatty liver.
2, diabetes: some data show that the incidence of fatty liver in diabetic patients is 21% ~ 78% (including type 1 and type 2 diabetic patients) and in obese patients with type 2 diabetes, the incidence of fatty liver is higher, accounting for 50% ~ 70%, mostly moderate or above, and most in obese type 2 diabetes in the early stage or early fatty liver has appeared.
3, hyperlipidemia: in recent years, the incidence of hyperlipidemia has been increasing year by year, has become the most important factor to induce fat, in hypertensive hyperlipidemic patients NAFLD is significantly higher than the general population, even in non-obese, non-diabetic hypertensive hyperlipidemic patients, the incidence of fatty liver is 2-3 times that of age, sex, weight-matched population. – 3 times.
4. Alcoholism: In China, daily intake of 40 g of ethanol for more than 5 years or daily intake of more than 80 g of ethanol for 5 d can lead to fatty liver.
5.History of taking drugs: Many drugs can reduce the metabolic capacity of the liver, such as hormones and the anti-arrhythmic drug amiodarone, which can lead to the accumulation of fat in the liver and the formation of fatty liver.
Are thin people not allowed to have fatty liver?
Although people who are overweight are more likely to get fatty liver, it does not mean that thin people will not get fatty liver. Some people, who are not fat, do not drink alcohol, do not take medication, do not have hepatitis, and eat very little and very lightly, are also found to have fatty liver, why? The liver not only synthesizes and breaks down fats, it is also a “transit point” for fat storage. The liver also synthesizes lipoproteins, which are the transport fleet for fat transfer from the liver to the outside of the liver, and people who are chronically malnourished have difficulty synthesizing enough lipoproteins due to a lack of protein in their bodies. The liver is unable to transfer excess fat outward, and this fat accumulates in the liver itself, resulting in a fatty liver. Therefore, fatty liver is not the exclusive property of fat people.
How should fatty liver be treated?
The principles of treatment for alcoholic liver disease include: reducing the severity of alcoholic liver disease through abstinence from alcohol and anti-inflammatory and anti-fibrotic medications; nutritional support to improve pre-existing secondary malnutrition; symptomatic treatment of alcoholic cirrhosis and its complications (such as esophagogastric variceal bleeding, spontaneous bacterial peritonitis, hepatic encephalopathy and hepatocellular carcinoma); liver transplantation is mainly used to treat end-stage liver disease and Liver transplantation is mainly used to treat patients with end-stage liver disease and severe alcoholic hepatitis for which conservative medical treatment has failed. Of these, abstinence from alcohol is the most important and needs to be maintained throughout life.
Treatment principles of non-alcoholic fatty liver disease.
1.Basic treatment.
(1) Develop a reasonable energy intake and dietary structure adjustment, moderate aerobic exercise, and correct poor lifestyle and behavior
(2) Avoid aggravating liver damage: prevent drastic weight loss, drug abuse and other factors that may induce liver disease deterioration
(3) Weight loss: weight loss can improve obesity with insulinemia, insulin resistance, diabetes mellitus, hyperlipidemia, and make fatty liver subside.
2.Pharmaceutical treatment.
(1) insulin sensitizer: combined with type 2 diabetes, impaired glucose tolerance, increased fasting glucose and visceral obesity, can consider the application of metformin
guanidine and thiazolidinediones, in order to improve insulin resistance and control blood sugar.
(2) Lipid-lowering drugs: There is evidence that the use of statin lipid-lowering drugs is safe and effective for patients with fatty liver.
(3) Liver transplantation.
It is mainly used for the treatment of patients with end-stage liver disease and partial cryptogenic cirrhosis with loss of liver function.
What should I pay attention to in my life to avoid fatty liver?
1, to achieve a reasonable diet: three meals a day with coarse and fine, often eat coarse grains, to ensure lower serum cholesterol, to ensure the body’s acid-base balance, and to provide the body with the necessary vitamin and food fiber supply.
2, moderate diet: control the amount of high-energy, high-fat, high-calorie foods, eat more side dishes, limit the main food, quit smoking and limit alcohol, and eat as little sweets, fried food and animal offal as possible.
3, appropriate exercise: can adhere to a certain amount of exercise to enhance the consumption of body fat.
4, careful use of drugs: drugs into the body have to go through the liver detoxification, in the choice of drugs should be careful to avoid further damage to the liver.
5.Adjust your mind: keep your mood open and avoid overstressing because of fatty liver detection.
6, scientific weight loss: control your mouth, move your legs, choose scientific weight loss drugs, and develop a suitable weight loss strategy.