Recently, the Health Channel conducted a survey on “fatty liver prevention and treatment knowledge”, with a total of 3604 users participating. The survey results are as follows.
80.34% of the respondents said they have family members or friends with fatty liver.
60.97% of the respondents believe that fatty liver is a chronic liver disease and has certain harmful effects. However, 39.03% of the respondents thought that fatty liver is a rich disease and has no harm.
81.63% of the respondents think that fatty liver does not need treatment as long as the liver function is normal and there are no symptoms.
73.22% of the respondents did not know that fatty liver is closely related to diabetes.
62.39% of the respondents did not know that fatty liver is prone to recurrence and needs lifelong prevention.
82.05% of the respondents did not know that excessive weight loss can lead to fatty liver.
32.48% of the respondents thought that fatty liver patients need to take liver-protective drugs.
From the above survey data, we can clearly see that although fatty liver is “loud” and its “scale” is no less than that of cardiovascular diseases, people’s awareness and attention to fatty liver is surprisingly shallow. The reasons for this are mainly related to the fact that fatty liver is not painful and people are not sufficiently aware of the dangers of fatty liver. In order to raise the public’s awareness of fatty liver, stimulate the “worry awareness” of fatty liver patients, and minimize the harm of fatty liver to human health, we invite experts in the field of fatty liver research in China to introduce 9 new ideas about the diagnosis and treatment of fatty liver, which we hope will be helpful to you.
Fact 1: Fatty liver is a disease, not a sub-health.
Popular opinion: Fatty liver is not a disease because it is not painful, at most it is a sub-health.
Professor’s view: Fatty liver is a metabolic stress liver disease, a chronic inflammation in the body, a common cause of chronic hepatitis, and a manifestation of metabolic syndrome in the liver, not a “subclinical state”.
Professor’s opinion: Having a fatty liver usually indicates an imbalance in the body’s energy metabolism, therefore, fatty liver is not only a disease of the liver, but also part of a systemic disease.
The development of fatty liver has gone through three stages: the first stage was from the 1960s to the 1980s, when fatty liver was only a “minor player” in the field of liver disease, not comparable to viral hepatitis, and alcoholic fatty liver was the main cause. The second stage was from the 1980s to the end of the 1990s, when the detection rate of non-alcoholic fatty liver increased dramatically, with a prevalence rate of 10%-15% in Western countries and about 10% in China. In the third stage, from 2000 to the present, the ranks of NAFLD patients have become even larger, with prevalence rates as high as 30% in developed countries and rising to 10%-15% in developing countries (about 15% in China). In China, there are 3 fatty liver patients out of 20 adults.
For a long time in the past, the nature of fatty liver, especially non-alcoholic fatty liver, was judged as benign. However, as research continues, there has been a major shift in the medical community in determining the nature of fatty liver, and it is considered likely that fatty liver is a non-benign disease! Some experts predict that in the next 20 years, fatty liver will become the leading cause of chronic liver disease and liver failure!
Research shows that 15% to 20% of simple fatty liver will develop into steatohepatitis in the next 5 to 10 years, and 30% to 40% of fatty liver hepatitis will progress to cirrhosis through liver fibrosis, eventually leading to liver failure or hepatocellular liver cancer. The results of this study are very positive. What is more noteworthy is that 50% to 80% of patients with steatohepatitis have metabolic syndrome, and the risk of cardiovascular disease in patients with fatty liver is 3 to 5 times higher than in the general population, and the occurrence of cardiovascular disease is often earlier than liver failure. Therefore, fatty liver patients need to face not only the danger of liver disease itself, but also other metabolic syndrome, cardiovascular and cerebrovascular diseases.
Fact 2: The outcome of fatty liver is very different when it is treated or not treated.
Popular opinion: Fatty liver can be treated or not, just take care of it yourself.
Professor’s view: Early intervention is necessary when you have fatty liver.
If you are concerned about your health, you should not ignore your liver, because there is no substitute for liver function and no liver means no life.
life). If you are concerned about liver, you cannot ignore fatty liver, because fatty liver has become the primary cause of chronic liver disease and liver function abnormalities in developed regions and affluent classes in China, and its incidence is still increasing and is trending towards lower age and universalization.
The primary causes include obesity, diabetes/abnormal glucose tolerance, hyperlipidemia, hypertension, etc. Secondary factors include alcohol, drugs, malnutrition, lipodystrophy, and acute pregnancy fatty liver. Alcoholic fatty liver is closely related to liver inflammation, liver fibrosis, cirrhosis and liver cancer. About 40% of alcoholic fatty liver is combined with alcoholic hepatitis, and the 5-year survival rate of patients with alcoholic hepatitis is less than 50% if they do not quit drinking or reduce the amount of alcohol consumed in time. It can be said that the prognosis of alcoholic steatohepatitis is not better than that of malignant tumors such as gastric cancer. Non-alcoholic fatty liver with obesity as the main cause can also develop steatohepatitis and cirrhosis and eventually die of liver failure and liver cancer like alcoholic fatty liver. The fatty liver is both an incompetent and extremely fragile organ that is highly vulnerable to drugs, industrial toxins, alcohol, ischemia and viral infections, leading to problems such as increased incidence of other types of liver disease, accelerated progression of the disease and increased difficulty in treatment. On the other hand, because fatty liver is an important part of the metabolic syndrome, patients with fatty liver are prone to hyperlipidemia, diabetes and hypertension, and have a significantly higher probability of coronary heart disease and stroke (stroke) within 10 years.
The dangers of fatty liver seem endless, but thankfully, with early detection and timely treatment, early mild cases of fatty liver can be reversed and the onset and progression of other metabolic syndromes can be slowed. For example, abstinence from alcohol is absolutely effective for alcoholic fatty liver, and fatty liver deposits in the liver can quickly subside if weight control is effective and reasonable. Conversely, if fatty liver is not treated early and allowed to develop, it will be difficult to recover completely when the disease progresses to the steatohepatitis stage. Not only will treatment take much longer (often more than half a year or even several years), but the effectiveness of treatment will also be greatly reduced (some patients may still progress even if the cause of the disease is removed).
Fact 3: Fatty liver is not the sole property of fat people, but can also be caused by excessive weight loss.
Popular opinion: Only fat people need fatty liver to “find” them, thin people don’t need to worry about it.
Professor’s view: fatty liver is not always fat people.
This is mainly in two cases: one is seemingly thin, but actually fat people. The so-called “fat people have fat liver”, fat people have a high incidence of fatty liver, the disease is also relatively heavy, this we can understand. However, unlike European and American people who are “big”, many Chinese people have “big stomachs and thin legs”, and may not be overweight, but their abdominal fat or visceral fat is already overweight. This kind of people belong to the abdominal obesity, as easy to get fatty liver with big fat people. There is also a situation where a person is really thin, but also has a fatty liver. This is mainly because after the body has consumed food, the excess calories are converted into fat and stored in the adipose tissue. The body’s adipose tissue is like a fat storage “warehouse”, there is a certain capacity. If the body synthesizes too much fat, more than the storage capacity of the “warehouse”, fat cells will “run” everywhere, “run” to the liver, heart and other places. Thin people have less adipose tissue, smaller “warehouses” and poorer ability to store fat. The fat is more likely to “run” to the liver, resulting in liver steatosis.
It is worth noting that weight loss too fast too Mongolian, or a period of great fluctuations in weight, but also easy to induce fatty liver. This is mainly because weight loss is actually a fat mobilization process, fat mobilization too fast and too fierce, more than the body’s metabolic capacity, fat will “run” everywhere, running to the liver, heart and other places, more harmful. By the same token, for patients with obese fatty liver, although weight loss is a proven treatment, it must be measured, that is, there must be a reasonable goal. Currently, a weight loss of 10% in six months is considered appropriate. A weight loss of more than 5 kg per month will lead to abnormal liver function and increase the risk of gallstone disease.
In addition, alcohol, medication or drug abuse can also lead to the development of fatty liver. Studies have shown that dozens of drugs may be associated with fatty liver, such as long-term high-dose use of adrenal glucocorticoids, tetracycline, synthetic estrogens, nifedipine, sodium valproate, amiodarone, and some lipid-regulating drugs.
Fact 4: The presence or absence of normal liver function and clinical symptoms do not correlate significantly with the severity of the disease.
Popular opinion: As long as the liver function is normal and there is no discomfort, a little fatty liver is not a big problem. If the liver function is not normal or you feel uncomfortable, it means the condition is serious.
Professor’s view: The determination of the severity of fatty liver disease should have a global concept, not only focusing on liver lesions, but also on the progress of other metabolic syndromes that accompany it.
Research shows that the clinical symptoms of fatty liver are non-specific, and most patients can have no conscious symptoms, while some patients can show symptoms such as malaise, distension in the liver area or other symptoms accompanying the metabolic syndrome. Most patients with simple fatty liver have normal transaminases, while a few patients with simple fatty liver may have elevated transaminases. 40-50% of patients with steatohepatitis have elevated transaminases, and the elevation is usually less than 3 times the upper limit of normal. In other words, even if the transaminases are not high (normal liver function), you may still have steatohepatitis. It is thus clear that the presence or absence of symptoms, their severity, and the degree of normal and abnormal liver function are not proportional to the degree of inflammation and fibrosis in the liver histology and, likewise, do not correlate significantly with the progression of other metabolic syndromes that accompany them. Therefore, one should never judge the severity of fatty liver based on the presence or absence of clinical symptoms or the normalcy of liver function based on perception, so as not to mislead the patient.
Fact 5: The treatment of fatty liver is a systematic project, not a personal one, and needs to be carried out under the guidance of a doctor.
Popular opinion: The treatment of fatty liver is nothing but “eat less and move more”, just pay more attention to yourself, there is no need to go to the hospital.
Professor’s view: The empty phrase “eat less and move more” alone cannot cure fatty liver.
Controlling diet and strengthening exercise are certainly the basic measures for treating fatty liver, but we must realize that the treatment of fatty liver is a long-term, systematic and systemic project that varies from person to person. Taking weight loss as an example, weight loss does not just mean weight reduction, but a serious scientific act. If you don’t lose enough weight, you won’t be able to achieve the treatment goal; if you lose too much weight, it will not only be difficult to stick to it, but also cause many complications, which will not be worth the loss. How to eat, what to eat, how much to eat, how to exercise, what kind of exercise to use, how to control the amount of exercise, and whether to supplement with medication, all of these must be done under the guidance of a doctor, not just a personal behavior.
At present, some medical institutions in China, such as our Renji Hospital, have opened specialized and special outpatient clinics for fatty liver, where gastroenterologists, endocrinologists, nutritionists and rehabilitation doctors are on duty at the same time to give fatty liver patients a full range of treatment services. The specific treatment process is as follows: First step, pre-screening. Measure height, weight, blood pressure, waist circumference, abdominal circumference and body fat for the doctor’s reference. Step 2, diagnosis and drug prescription. Patients go to the gastroenterology and endocrinology doctors, who will formulate a clear diagnosis and medication recommendation based on the medical history, physical examination and laboratory tests. Step 3: Nutrition prescription. Based on the patient’s height, weight, abdominal circumference, body fat, degree of liver fat and underlying diseases, the nutrition doctor will formulate a personalized nutrition prescription, including how much total calorie intake per day, how to reasonably match nutrients, which foods must be eaten and which foods are best not eaten. The fourth step is exercise prescription. Based on the patient’s age, gender, weight, basal heart rate and other conditions, the rehabilitation doctor will make a reasonable exercise plan, such as how to exercise, when to exercise, how long to exercise, etc. In other words, patients with fatty liver should be given three prescriptions after consultation – drug prescription, exercise prescription and nutrition prescription. Clinical practice shows that the only way to receive significant results is to have a “three-pronged approach”. If any one of them is neglected, you will get half the result with twice the effort.
Fact 6: The treatment of fatty liver does not depend on drugs but on perseverance.
Public opinion: Is there any medicine that can cure fatty liver, since lifestyle habits cannot be changed overnight?
Professor’s opinion: There is no “magic pill” that can cure fatty liver.
Despite the rapid development of medicine and the emergence of new drugs, there is no panacea for fatty liver. Currently, for patients with fatty liver caused by alcohol and obesity, treatment is mainly devoted to removing or reducing the two major risk factors that lead to liver damage —- alcoholism and obesity. In other words, relying on one’s own perseverance to abstain from alcohol and lose weight for a long time, one can achieve the goal of reducing or even curing fatty liver. Measures such as diet moderation, increasing exercise and reducing alcohol consumption are more important than medication for fatty liver, a malpractice-related disease, especially for simplex fatty liver. Abstinence from alcohol is absolutely effective for alcoholic fatty liver. Fatty deposits in the liver are usually reduced or subside within a few weeks of abstinence from alcohol, and inflammatory damage to the liver may return to normal within six months to a year. Similarly, weight loss may be the only effective treatment for patients with simple fatty liver due to obesity.
It must be clear that in the comprehensive treatment of fatty liver, drug therapy is only a phased, adjunctive treatment. Rather, it is the modification of their diet, exercise and maladaptive behaviors that require a high degree of long-term attention and adjustment by the patient. These non-pharmacological measures are the foundation of the overall treatment of fatty liver and usually need to be carried out for the rest of the patient’s life, otherwise the fatty liver will recur even after it is cured. Therefore, patients with fatty liver must understand the importance of being proactive in their treatment and strive to identify and correct their poor diet and lifestyle habits, and never assume that they can get healthy simply by spending money on medications. If you put your hopes only on medications and do not pay attention to the underlying treatment, you will certainly not achieve satisfactory results and may induce drug-derived diseases. For the masses who have solved the problem of food and clothing, what is lacking is not nutrition, but exercise; what is urgently needed is not supplements, but a scientific way of life. As long as we can achieve “reasonable diet, less alcohol, more exercise, reasonable use of drugs”, we can stay away from the threat of fatty liver.
It should be reminded that there is no herbal remedy at home and abroad that can completely reverse all kinds of fatty liver. Some advertisements claiming that special herbal medicines can cure fatty liver are unreliable, and these prescriptions have not been verified by strict clinical trials. In addition, long-term high doses of Chinese medicine, especially compound Chinese medicine, may lead to liver and kidney function damage and other pharmacogenic diseases, and the concept of “Chinese medicine is not toxic” should be abandoned.
Fact 7: The harm of fatty liver is not only limited to the liver.
Popular opinion: Fatty liver is just too much fat in the liver, no big harm, much “kinder” than diabetes and coronary heart disease.
Professor’s view: Fatty liver is in the same vein as diabetes and coronary heart disease, and fatty liver patients face many chronic disease threats.
Unlike chronic viral hepatitis and alcoholic fatty liver, the danger of non-alcoholic fatty liver is not only limited to the liver. The contribution of fatty liver to disorders of glucolipid metabolism and its related events far exceeds that of hepatitis and liver fibrosis. The main factors affecting the survival and quality of life of the majority of patients with fatty liver are diabetes and atherosclerosis-related cardiovascular diseases, not cirrhosis of the liver.
Epidemiological surveys have found that the prevalence of fatty liver is high and severe in patients with obesity, diabetes, and hyperlipidemia. Many patients with fatty liver were in the normal range of weight, lipids, blood glucose and blood pressure at the time of diagnosis, but further follow-up studies revealed that these patients rapidly developed hyperlipidemia, diabetes and atherosclerosis and their related complications within a few years of fatty liver detection. I have followed 358 patients with fatty liver detected by ultrasound as well as 788 employees of a Shanghai company for an average of 6 years. It was found that patients with fatty liver were more prone to new metabolic disorders than the control population – the incidence of obesity, hypertriglyceridemia, hypercholesterolemia, hypertension, and diabetes were significantly higher than in the control population.
It is now believed that fatty liver is an independent risk factor for complications of cardiovascular disease in patients with type 2 diabetes. Fatty liver is an early lesion of diabetes and atherosclerosis, and fatty liver is in the same vein as diabetes and atherosclerosis. Cardiovascular events and diabetes mellitus may be earlier, more frequent and more fatal than cirrhosis in patients with fatty liver. Therefore, patients with fatty liver should also enhance the treatment of systemic diseases, such as hypotension, glucose and lipid lowering, while treating their fatty liver.
Fact 8: A normal ultrasound report does not completely rule out fatty liver.
Popular opinion: Last year, I had an ultrasound and it said I had fatty liver. This year, I had it done again, and it said I didn’t have fatty liver. Now I can take off my “fatty liver hat”, right?
Professor’s opinion: Ultrasound examination can only detect cases of moderate liver steatosis or above.
The accuracy of ultrasonography in diagnosing fatty liver is generally 60% to 70%. The fatty liver that can be detected by ultrasound is generally a moderate fatty liver with a steatosis of 33% or more. In other words, mild fatty liver with less than 33% liver steatosis can easily be missed. In order to improve the detection rate of fatty liver, CT and wave-spectrum MRI have been gradually carried out in the clinic. Spectral MRI, in particular, can detect mild cases of fatty liver with only 5% hepatic steatosis and can measure the triglyceride content of the liver.
It should be noted that the diagnosis of fatty liver should not rely solely on ultrasonography, but should be based on a comprehensive analysis and judgment based on medical history, weight, abdominal circumference, body fat, and whether other diseases are combined. Researchers in the United States have performed liver puncture examinations on hundreds of patients with obese metabolic syndrome who were asymptomatic and had normal liver function and ultrasound examinations. Some foreign experts advocate that even if there are no abnormal findings on ultrasound, as long as there is a history of diabetes for more than 5 years, the patient can be considered to have a fatty liver.
Fact 9: Fatty liver in children is more dangerous than fatty liver in adults.
Popular opinion: Fatty liver is an adult disease and children generally do not get it. Even if they do get it, it is benign and not very harmful.
Prof. Zeng Minde’s view: In the past, fatty liver in children was considered to be a benign disease, but now it is considered to be a disease with extremely serious consequences.
Several foreign studies have shown that children with fatty liver have a higher chance of liver inflammation and liver fibrosis. If left untreated, children with fatty liver are at a much higher risk of developing diabetes and hypertension in the future. If children with fatty liver disease are combined with other liver diseases, it will be much more difficult to treat them. What is of concern is that the prevalence of fatty liver in children is increasing (from 3% before 2000 to 6%-8% at present) and is also trending towards a younger age (from a prevalence of 12-16 years in the past to occurring before the age of 12 at present). It has been reported that the youngest patient with fatty liver and cirrhosis in the world is only 6 years old!
Unlike adults with fatty liver, the treatment of fatty liver in children faces a more difficult test: since children are in a period of rapid growth and development, how to grasp the degree of weight loss, so as to ensure the efficacy of treatment without affecting their growth and development, is the first hurdle; at the same time of treatment, always pay attention to the psychological state of children, so that fatty liver does not become a psychological burden for children, is the second hurdle; children have poor self-control, how to ensure The third hurdle is to ensure the smooth implementation of treatment measures. If the treatment of fatty liver in adults is a matter of concern for both doctors and patients, then the treatment of fatty liver in children is a matter of concern for doctors, children, their families and society. Since the main causes of fatty liver in children are obesity and diabetes, the key to preventing fatty liver in children is to actively prevent it, encourage children to develop good living and eating habits from a young age, and eliminate the occurrence of obese children.
Treatment of fatty liver requires a “holistic approach”
Fatty liver is a component of the metabolic syndrome, and the harm of fatty liver is not only in the liver, therefore, the diagnosis and treatment of fatty liver cannot be limited to gastroenterology, but also involves endocrine, cardiovascular, nutrition, rehabilitation and other disciplines, and advocates individualized treatment and comprehensive treatment. As a patient, once you are diagnosed with fatty liver, you should be prepared for long-term treatment. As a doctor, you should not regard the process of seeing a doctor as a “prescription” process, thinking that a single prescription can solve the disease at once, but should pay attention to the importance of basic treatment (diet, exercise, lifestyle changes). For every fatty liver patient a doctor sees, he or she must be prepared to follow up carefully for 20 years.
Patients with fatty liver should take their medications with careful consideration
Patients with simple fatty liver who do not have significant weight loss and no significant improvement in intrahepatic fat deposition after six months of basic treatment with diet and exercise can be appropriately treated with weight loss drugs. Patients with steatohepatitis (with elevated transaminases) can choose liver-protective drugs such as polyenyl phosphatidylcholine, vitamin E, Yihelin, ursodeoxycholic acid, etc. to promote the regression of intrahepatic fatty deposits, stop the progression of intrahepatic inflammation and fibrosis, and reduce the occurrence of cirrhosis. Patients with fatty liver with hyperlipidemia need to decide whether to use lipid-lowering drugs at their discretion according to the type and degree of hyperlipidemia. Children, adolescents, pregnant women, and elderly people over 75 years old with new-onset hyperlipidemia generally do not need lipid-lowering drugs. Patients with fatty liver who have hypertension and diabetes should be treated with glucose- and lipid-lowering drugs under the guidance of a physician.
To avoid possible aggravation of the disease caused by taking medication, it is recommended that patients must pay attention to the following two points while taking medication.
(1) Take the medication strictly according to the doctor’s prescription, do not buy the medication on your own by hearsay. The dose of medication should not be too large, and there should not be too many types of medication. To avoid drug interactions, it is best to take Chinese and Western drugs separately. If they must be taken at the same time, the interval should be 2 to 3 hours.
②Strengthen the monitoring during the medication period and review the liver function and liver ultrasound regularly. Patients with fatty liver who need to use lipid-lowering drugs should strengthen regular follow-up for two reasons: first, lipid-lowering drugs have certain hepatotoxicity; second, while lowering blood lipids, lipid-lowering drugs will prompt the liver to increase fat uptake and synthesis, which may aggravate the steatosis of the liver.
Pay attention to the regular evaluation and long-term follow-up of the treatment effect of fatty liver patients
The treatment of fatty liver depends half on doctors and the other half on patients themselves. Doctors formulate reasonable prescriptions for drugs, nutrition and exercise, i.e. comprehensive treatment plans, based on the actual situation of the patient’s etiology, liver function and disorders of glucolipid metabolism; patients should change their established poor lifestyles according to their doctors’ requirements. The effectiveness of the treatment depends on the reasonable individualized and comprehensive treatment plan formulated by the doctor and the implementation of the patient. The harmful nature of fatty liver determines that the regular evaluation of the treatment effect should focus on the development and progression of other metabolic syndromes in addition to the progression of liver lesions. At different stages of treatment, the patient’s liver function condition, glucose and lipid metabolism disorders and other metabolic syndrome conditions may change differently, and regular monitoring and adjustment of the comprehensive treatment plan is an important tool for effective treatment of fatty liver. For the liver, fatty liver is a chronic liver disease, and for the whole body, fatty liver is an independent risk factor for complications of cardiovascular disease in type 2 diabetic patients, and the incidence of cardiovascular and cerebrovascular events in them is higher than that in the general normal population. Therefore, patients with fatty liver should be monitored and followed up for a long time, and reasonable comprehensive treatment measures should be taken to minimize the harm of the disease to the body.