The danger of fatty liver should not be underestimated
At present, the prevalence of NAFLD is about 10%-20% in China, and the better the material condition of the city, the higher the prevalence.
Fatty liver has a genetic susceptibility and is associated with environmental factors and metabolic stress, insulin resistance is an important mechanism, and usually obese people, diabetic and hyperlipidemic patients are more likely to develop fatty liver. In addition, the poor lifestyle of modern people is also an important factor that leads to the increase of fatty liver, such as eating a diet high in fat, sugar, high energy food, love to eat late at night, as well as exercise too little, may be quietly stalked by fatty liver. Of course, there are also a very small number of people with fatty liver due to malnutrition, which are mostly found in remote mountain villages, and some people who deliberately lose weight.
Because NAFLD itself is generally a benign disease, the risk is usually not serious, so it has been underestimated in the past, and some patients tend to be indifferent to it and allow it to develop. However, in recent years, the dangers posed by fatty liver have become increasingly clear. If left unchecked, simple fatty liver can develop into steatohepatitis, which can progress to cirrhosis and, more importantly, the associated metabolic problems increase the incidence of cardiovascular disease and mortality. Therefore, the dangers of fatty liver should not be underestimated, and we especially want to remind the public of the two major potential dangers of fatty liver.
Hazard 1: It has an impact on the whole body metabolism
With fatty liver, disorders of glucose metabolism and lipid metabolism may occur, which may lead to cardiovascular diseases and type 2 diabetes.
Hazard two: the liver’s ability to tolerate deterioration
We know that the liver is an important detoxification organ. In the past, it was neglected that the liver’s tolerance ability would be weakened after having fatty liver, but now it is called “fatty liver’s susceptibility to liver cell damage”, which is a new concept that has been introduced in the past three to four years. Some drugs, such as antipyretic and analgesic drugs taken after a cold, are well tolerated by people with normal livers and rarely have any effect, but in patients with fatty liver, they may cause an acute event of liver function damage. All drugs that are toxic to the liver have the potential to produce more serious damage to the liver on top of the fatty liver.
Therefore, Professor Ji reminds that although fatty liver is a benign disease, it is not less harmful. Once fatty liver is detected, it is still important to seek medical advice and take the necessary tests and treatment from a specialist.
How to detect fatty liver without specific symptoms early
When it comes to the symptoms of fatty liver, most patients have the experience that there is nothing unusual about them, but when the physical examination report comes out, the conclusion of fatty liver is clearly indicated. Indeed, many patients are found by chance during a physical examination.
In a multicenter study done about 10 years ago on nearly 800 cases of fatty liver, about 29% of the patients had no symptoms. Some patients may have abnormal liver function tests (mainly elevated transaminases), and in the United States, fatty liver is the cause of elevated transaminases in more than half of patients.
In general, fatty liver does not have very specific symptoms, and it is not clearly defined from other liver diseases in terms of symptom presentation. A relatively common clinical symptom is fatigue, and some patients may experience discomfort in the liver area, mainly in the form of stuffiness and swelling, or in a few cases, vague pain in the liver area. However, the clinical performance varies greatly among individuals, and the severity of fatty liver and the symptoms are not necessarily proportional. Some patients have severe fatty liver but may not feel it at all, while others have very mild fatty liver but show more obvious discomfort.
With the improvement of people’s health awareness, in recent years, people pay more and more attention to medical checkups, and there are few patients with fatty liver found in medical checkups. Professor Ji says that ultrasound is the first choice, and generally, a liver ultrasound is all that is needed to detect fatty liver, which is a very simple, fast, effective and affordable test. Do we need any other tests to diagnose fatty liver? Professor Ji suggests that based on the ultrasound, further diagnosis can be chosen based on the individual patient’s condition.
The advantage of CT over ultrasound is that it can show focal fatty liver, whereas ultrasound shows a hypoechoic image of fatty liver, which is also seen in tumors. In addition, CT has the advantage of being able to semi-quantify the diagnosis of fatty liver based on the CT values of the liver and spleen. In the last two years, MRI can also provide a relatively accurate quantification of the fat content in the liver, but this technique is not yet fully disseminated, and with the development of imaging, it may become a new direction in fatty liver imaging diagnosis.
There are also a number of indicators that are very helpful in the diagnosis and evaluation of fatty liver that need further clarification. For example, body mass index, which is usually a very important factor, since many patients will have concomitant obesity. Again, since fatty liver has an impact on the entire metabolism, blood glucose and liver function should be evaluated. All these assessments are beneficial for the subsequent treatment.
For some specific types.
(1) Those with abnormal liver function and insignificant recovery through standardized treatment, which may have steatohepatitis and progressive liver fibrosis.
(2) Combined metabolic syndrome as well as NAFLD fibrosis score can be used to identify those at high risk for steatohepatitis and progressive liver fibrosis.
(3) Liver biopsy is recommended when non-invasive measures are difficult to exclude other causes of hepatic steatosis or to determine the presence of other coexisting chronic liver diseases.
In short, all these tests have their existence. If the doctor asks the patient for further tests, it is recommended that the patient and the doctor communicate with each other as necessary, and can listen and ask questions to clarify the condition before proceeding to follow-up treatment.
One direction for fatty liver treatment
When it comes to the treatment of fatty liver, Prof. Ji points out that “diet control” + “strengthening exercise” is the most important treatment method, and it is also the internationally recognized method that is really effective in the treatment of fatty liver so far. The rest of the treatment methods are mainly for the treatment of fatty liver associated diseases, such as weight loss for obese patients, blood sugar control for diabetic patients, and lipid-lowering treatment for hyperlipidemic patients. There are also some potentially effective treatments for concomitant diseases in Western medicine, such as lecithin therapy for disorders of lipid metabolism, insulin sensitizers for insulin resistance, antioxidant therapy for abnormal liver function, and high doses of vitamin E abroad for severe fatty liver.
In China, there is also the means of Chinese herbal medicine for fatty liver treatment. Generally speaking, TCM treatment of fatty liver has to be evidence-based and different people have different experiences. In the past, it was more believed that the treatment of fatty liver required strengthening the spleen, activating blood circulation and resolving phlegm. The research led by Prof. Ji is not very consistent with the traditional Chinese medicine treatment of fatty liver. They have done a survey in the early stage to see which symptoms the patients show, and the result is that there are mainly three types of patients: 1) Damp-heat; 2) Damp-heat with blood stasis; 3) Spleen deficiency related to the disease. The first type of patients that can be treated with Bile Ning Tablets are those with damp-heat evidence.
For treatment, it should also be reminded that no matter what kind of treatment is taken and what kind of therapeutic drugs are used, it must be done under the guidance of a professional physician. Even Chinese medicine is not 100% free of side effects and absolutely safe, so the use of Chinese medicine treatment must be carried out under the guidance of a professional herbalist.
Do three things to prevent fatty liver
Fatty liver is a type of disease that can be prevented, and mild fatty liver can be reversed.
1, reasonable meals
Three meals a day should be reasonably well-deployed, so that the coarse and fine match, nutritional balance, a sufficient amount of protein can remove fat in the liver. In particular, it should be noted that high-fat, high-sugar, high-calorie food to eat less, carbonated beverages, fried chicken and fries, are very bad food, do not greedy mouth and tongue, but will be healthy to refuse the door.
2, appropriate exercise
Adhere to physical exercise every day, depending on their own physique to choose the appropriate sports, such as jogging, brisk walking, playing table tennis, badminton, swimming, cycling, dancing and other sports; to start with a small amount of exercise, step by step, and gradually reach the appropriate amount of exercise to strengthen the consumption of body fat.
For patients who already have fatty liver, the intensity needed to treat fatty liver through exercise is different from the intensity needed to prevent fatty liver; in most cases the intensity should be greater, generally requiring an exercise with a heart rate of (170-age) beats/min and a duration of between 40 minutes and one hour. In order to achieve an effective amount of exercise and reduce accidental injuries caused by exercise, it is important to find a professional physician for assessment and guidance before exercise, and to develop a practical exercise plan to achieve the purpose of reducing fatty liver and metabolic disorders in a safe manner.
3, careful use of drugs
The liver is the body’s chemical factory, any drugs entering the body have to be detoxified by the liver, so usually do not move to take drugs, no matter how much the market health care products or drugs blow, when using drugs must be careful. For patients with symptomatic fatty liver, we should be more cautious when choosing drugs, beware of the toxic side effects of drugs, especially drugs that are damaging to the liver should be especially cautious to avoid further aggravation of liver damage as much as possible.
In addition to the above three rules, it is also important to maintain a cheerful mood, less irritation, no anger, and a combination of work and rest.