During health checkups, we often find that some seemingly healthy people have fatty liver, which some people do not understand. They think they have a normal diet, normal bowel movements, and no discomfort, so how can they have fatty liver? In fact, this is not true. According to statistics, the incidence of fatty liver is 10%, the incidence of fatty liver in obese people and type 2 diabetics is 50%, alcoholics is 57.7%, people over 50 years old is 24.5%, and the incidence of the population is getting younger.
A. What is fatty liver
Fatty liver is a lesion caused by excessive accumulation of fat in liver cells for various reasons. In normal people, the fat content of the liver accounts for only 3%-5% of the wet weight of the liver, while in patients with fatty liver, the fat content of the liver exceeds 10%-15% of the wet weight of the liver, or 40%-50% of the hepatocytes are histologically fatty, mainly triglycerides.
Fatty liver is commonly known as: “fat liver” – the liver is fat due to excessive fat accumulation; bright liver” – on the ultrasound image, white highlights of liver fat reflection can be seen, the stronger the brightness, the higher the steatosis in the liver.
II. Classification
Fatty liver can be divided into two categories, acute fatty liver and chronic fatty liver, according to the urgency of the onset of the disease.
Acute fatty liver includes: pregnancy toxic fatty liver, the
Tetracycline Toxic Fatty Liver;
Chronic fatty liver is mostly seen in: obesity fatty liver.
diabetic fatty liver.
Post-hepatitis fatty liver.
Alcoholic fatty liver.
Malnutrition fatty liver
Acute fatty liver is less common in clinical practice, so we focus on chronic fatty liver.
In 2001, the Fatty Liver and Alcoholic Liver Disease Group of the Chinese Medical Association Hepatology Branch divided chronic fatty liver into alcoholic fatty liver and non-alcoholic fatty liver.
Alcoholic fatty liver is a liver disease caused by long-term heavy alcohol consumption, which is usually manifested as simple fatty liver at the beginning, and then can develop into alcoholic hepatitis, abnormal liver function, and even alcoholic liver fibrosis and alcoholic liver cirrhosis. In severe alcohol abuse, extensive hepatocellular necrosis or even liver failure can be induced. Patients often have a long history of alcohol consumption, usually more than 5 years, with an alcohol equivalent of greater than or equal to 40g/day for men and greater than or equal to 20g/day for women, or a history of heavy drinking within 2 weeks, with an alcohol equivalent of greater than 80g/day. (The alcohol amount conversion formula is: amount of alcohol consumed (ml) x alcohol content (%) x 0.8 = g)
Another major category of fatty liver is non-alcoholic fatty liver, which is a clinicopathological syndrome with histopathological changes in the liver similar to those of alcoholic fatty liver, but without a history of excessive alcohol consumption. It usually includes simple fatty liver and non-alcoholic steatohepatitis, which is often combined with liver fibrosis and can progress to cirrhosis. NAFLD is one of the most common liver diseases in Western developed countries, accounting for 20-30% of the general adult population. Its prevalence is also increasing year by year in the Asia-Pacific region, with the population prevalence fluctuating between 10% and 45%. In China, the incidence of fatty liver has also increased significantly with the development of social economy, improvement of people’s living standard and changes in diet structure. Current research has confirmed that the onset of the disease and visceral obesity and insulin resistance and metabolic syndrome have a close relationship.
Third, who are most likely to get fatty liver
1, alcoholic, alcoholic people (white wine, beer)
2, obese people (centripetal obesity, waist circumference increased significantly)
3, people with excess nutrition (hyperlipidemia, especially high triglycerides)
4, malnourished people (such as weight loss)
5, people with diabetes (especially adult non-insulin-dependent diabetic patients)
6, people with hepatitis (acute liver recovery, slow liver resting period uncontrolled increase in high nutrition and high calorie diet resulting in excess nutrition)
7. Middle-aged and elderly people who have too little activity
Fourth, the formation of the original cause of fatty liver
Let’s talk about how the fatty liver is formed. The liver is the central organ of fat anabolism and decomposition, but it does not store a large amount of fat, it is a limited space “warehouse”. When the breakdown and synthesis of fats in the liver are out of balance, or when the output is impaired, cholesterol, triglycerides and free fatty acids can accumulate in excess in the liver cells, resulting in a fatty liver. If we look under the microscope, we will see that the liver cells have been filled with a large number of fat droplets, imagine, can such “squeezed” liver cells work properly?
The causes of fat metabolism disorders in the liver can be single or a combination of factors. The causes are
1, excessive food intake, the supply of fat, sugar and other high-calorie substances than the body’s normal needs;
2, the body can promote the metabolism of certain substances to reduce, resulting in a large accumulation of fat in the liver;
3, the use of glucose in the body can not be carried out normally (ultra-early stage of diabetes), resulting in a large amount of fat in the fat cells in a free state into the blood and subsequently into the liver, thus causing the liver to synthesize a large amount of fat (excess sugar can be converted into triglycerides in the body).
4 Liver cells are injured by alcohol, chemical toxins, hepatotoxic drugs, hepatitis viruses, etc., resulting in impaired metabolism and utilization of fat and other substances, which in turn cannot be transferred out of the liver, resulting in fat accumulation in the liver.
V. Diagnosis of fatty liver.
It mainly relies on medical history, clinical manifestations and laboratory tests, especially ultrasound and CT can detect fatty liver at an early stage, but confirming the diagnosis depends on liver biopsy.
1.History: history of long-term alcohol consumption, obesity, diabetes, nutritional disorders and toxic liver damage.
2, clinical manifestations: may be asymptomatic or have loss of appetite, nausea, fatigue, discomfort or vague pain in the liver area.
3, laboratory tests: normal or mildly elevated liver function ALT, elevated lipids, elevated serum g-GT, elevated protein electrophoresis plasma globulin.
4.Ultrasound and CT: Ultrasound shows enlarged liver, dense strong reflective light spots in liver parenchyma, deep tissue echogenic attenuation. CT scan shows lower density of liver than other parenchymal organs (e.g. spleen).
5.Liver biopsy: hepatocyte steatosis and fat storage, visible as large vesicular fat droplets.
Six, the harm of fatty liver
1.The direct harm of fatty liver: damage to liver function
After suffering from fatty liver, liver cells undergo different degrees of steatosis, so that the liver loses its normal function. This is a process of gradual change. In the early stage, the liver function of patients may be normal, but with the aggravation of hepatocyte steatosis, the function of hepatocytes will be lost more and more, which finally leads to the gradual death of hepatocytes and the development of cirrhosis.
2, the indirect harm of fatty liver: is a more important issue
From the perspective of the cause of fatty liver, it is a manifestation of “abnormal glucolipid metabolism” in the liver. If this “abnormal glucose and lipid metabolism” is not effectively controlled, not only will the fatty liver gradually aggravate, but the abnormal glucose metabolism can also develop into diabetes; when the abnormal lipid metabolism is serious, hyperlipidemia, gout, atherosclerosis, hypertension, coronary heart disease, cerebral infarction and a series of irreversible modern diseases that seriously affect human health. The fatty liver is like a mirror. Fatty liver is more like a mirror that can reflect the earlier disorders of glucose and lipid metabolism, and at this time, to a certain extent, the disease is still reversible, and it is also a good time for early treatment.
What should I do if I have fatty liver?
Since mild fatty liver has no clinical symptoms, it is easy to be ignored, and many patients with fatty liver are found by chance during physical examination, so they think that fatty liver has no big impact on human body. Some people are very scared after being diagnosed with fatty liver, so they seek medical help and medicine everywhere, which adds a lot of worries to themselves. Therefore, to understand fatty liver correctly, people must get out of two misconceptions.
First, do not be too nervous. Some people are talking about liver, found to have fatty liver after worrying, this is completely unnecessary. Fatty liver is due to the deposition of fat in the liver and is not contagious. It is a reversible disease, such as timely detection, reasonable treatment and exercise, is completely able to stop its further development, or even cure.
Second, do not take it too lightly. Although fatty liver is a benign lesion, but its main danger is easy to lead to liver fibrosis and cirrhosis. Some data show that 30% of alcoholic fatty liver can develop into liver fibrosis, 10% to 40% will eventually develop into cirrhosis; non-alcoholic fatty liver has a 25% chance of liver fibrosis, and a 1.5% to 8% chance of cirrhosis. Once cirrhosis occurs, it is a sign of liver function damage, ascites, varices, and even gastrointestinal hemorrhage and finally death. In addition, fatty liver can also make people reduce the ability to defend against bacteria and viruses, etc., and can also affect the recovery of other diseases, so it is also important to pay attention to fatty liver.
VIII. Treatment of fatty liver
Once fatty liver is detected, patients should carry out reasonable health care. Removing the causes of the disease (quitting alcohol, losing weight, treating the original disease), reasonable diet, strengthening exercise, controlling weight and regulating emotions are the keys to treating fatty liver. Good living and eating habits and attention to adequate rest are the basis of a healthy body.
1, diet therapy: is the basic method of treatment for most fatty liver patients, the cause of the disease is different, the focus of diet and nutrition is different, and should be carried out under the guidance of doctors and dietitians. As we all know, the source of caloric energy is protein, fat and sugar in food. Excessive caloric energy intake can make people gain weight and increase fat synthesis, thus accelerating the fatty degeneration of liver cells. Therefore, a reasonable diet should be developed and adhered to. Diets rich in lipophilic substances such as lean meat, fish, egg whites and fresh vegetables can help promote the elimination of fat in the liver, and foods high in fiber (such as corn, coarse wheat flour flakes, brown rice, hard fruits, beans, mushrooms, kelp, fungus, duck pears, konjac, etc.) can help increase satiety and control blood sugar and blood lipids, which is especially important for fatty liver caused by excess nutrition. This is especially important for fatty liver caused by overnutrition.
At the same time, attention should be paid to reasonable water consumption, generally adults need to drink 2000ml of water daily, the elderly 1500mL, obese people.
The best choice of drinking water is plain water, mineral water, purified water and light tea, etc. Do not drink all kinds of drinks, milk and coffee instead of water. If it is over-nutritional fatty liver people, drink water 20 minutes before meals, so that the stomach has a certain sense of fullness, can reduce appetite, reduce the amount of food, and help to lose weight.
A reasonable mix of the three nutrients is the key, i.e. increase the intake of protein, pay attention to the quality and quantity of fat, and the sugar diet should be moderate. It should be reminded that people with fatty liver should have a low-fat diet and should eat mainly vegetable fats, as much monounsaturated fatty acids (such as olive oil, canola oil, tea oil, etc.) as possible, and as little saturated fatty acids (such as lard, butter, mutton oil, butter, cream, etc.) as possible, while the intake of cholesterol should be limited, such as animal offal, brain marrow, egg yolk, fish eggs, squid, etc. In terms of sugar intake, one should eat a diet low in sugar and not eat foods rich in monosaccharides and disaccharides, such as high-sugar pastries, ice cream, dried dates and candy.
Behavioral therapy is also one of the treatment measures. People with fatty liver should also be determined to change their bad eating habits and practice a regular diet of three meals a day. Any irregular eating patterns such as gluttony, intermittent eating, fast food, snacking, night eating, overeating, weekend gorging, skipping breakfast, too rich dinners, eating before bedtime and wanting to eat when in a bad mood can cause excessive accumulation of body fat, disrupting the body’s metabolic dynamics and providing conditions for the onset of obesity and fatty liver. In addition, eating too fast is not easy to produce a sense of satiety, easy to promote obesity because of excessive energy intake.
2, exercise therapy: medical research shows that exercise is a very good way to promote the body’s use of sugar and fat, a certain amount of daily exercise can rejuvenate the body’s cells, improve the disorder of sugar and fat metabolism and enhance the function of the body’s organs. People with fatty liver mainly choose aerobic exercises, such as jogging, medium and fast walking (115-125 steps/minute), cycling, going up and down stairs, climbing, playing badminton, playing shuttlecock, patting the ball, dancing, doing radio gymnastics, jumping rope and swimming, etc. These exercises are more effective in reducing fat and weight loss and promoting fat receding in the liver.
The intensity of exercise should be moderate, with a pulse of 100 to 160 times/minute (170 – actual age), lasting 20 to 30 minutes, and fatigue disappearing within one to 20 minutes after exercise. Some people also believe that the size of the exercise to achieve faster breathing, slight sweating and then adhere to the exercise for a period of time is appropriate.
The best time to choose to exercise in the afternoon or evening; the best time to walk is one hour after dinner, when the maximum calorie consumption, weight loss is also the best effect. The frequency of exercise implementation to 3 to 5 days a week is more appropriate, the specific should vary from person to person, according to the degree of obesity of the implementer, spare time and the hobby of exercise and other factors to decide. If the fatigue after the exercise does not last until the next day, the exercise can be carried out every day.
3.Medication: So far, there is no effective drug to prevent and treat fatty liver. Generally, we often use hepatocyte protection, lipid removal drugs and antioxidants, such as vitamin B, C, E, lecithin, ursodeoxycholic acid, silymarin, inosine, coenzyme A, reduced glutathione, taurine, hepatocyte, and certain lipid-lowering drugs, etc. In recent years, with the in-depth understanding of non-alcoholic fatty liver and diabetic insulin resistance, diabetes treatment drugs have started to be applied in the treatment of fatty liver. Although there are many drugs mentioned above, most of them still need further verification of their efficacy and safety, therefore, they should be used correctly under the guidance of doctors and should not be abused.
4.Chinese medicine treatment: In recent years, the research of Chinese medicine on fatty liver has been gradually deepened, and Chinese medicine adopts the combination of evidence and disease identification, multi-channel and multi-level overall control treatment method, and clinical treatment has made promising progress, which shows the unique advantages of safe and effective, stable efficacy compared with western medicine treatment. According to Chinese medicine, the disease is mostly caused by excessive consumption of fatty, sweet and thick flavors, excessive alcohol consumption, or emotional and mental disorders, or chronic physical deficiency, resulting in loss of liver drainage, loss of spleen health, loss of kidney essence, and accumulation of dampness, phlegm, blood stasis and other pathological factors in the liver. The nature of the disease is a deficiency in the liver, and is closely related to the dysfunction of the spleen, kidney and other internal organs. Current treatment methods include evidence-based treatment, addition and subtraction of basic prescriptions, fixed compound prescriptions, single-medicine, Chinese and Western medicine, and other traditional medical therapies (such as acupuncture and moxibustion, auricular pressure), etc.; however, evidence-based treatment is still the main and common clinical treatment method.
Spleen deficiency and dampness: over-eating fatty, sweet and thick flavors and long-term alcoholism, easy to produce dampness and turbidity, is one of the main reasons for the occurrence of the disease. If the spleen is injured, it is unable to transport water-dampness and water-grain essence, and water-dampness stops inside, dampness turns into heat, refining liquid into phlegm, and phlegm and turbidity grow inside, blocking the veins and channels and invading the liver veins, causing the liver to lose its nourishment and depositing phlegm and turbidity. The disease is located in the liver and has its roots in the spleen. Symptoms include physical drowsiness, distension and fullness of the rib cage, vomiting and vomiting with little food, and in women, lingering banding, a light red tongue with teeth marks on the side, thin white or thin greasy moss, and a smooth or sunken pulse. Treatment, strengthen the spleen and benefit the qi, treatment is often selected astragalus, atractylodes, poria, yam, atractylodes with yujin, aromatic herb, red peony, etc.
Kidney qi loss type: fatty liver onset in the middle-aged and old people, at this time, the kidney in the essence of the decline, qi and blood gradually loss, coupled with excessive fatigue, diet, or work rhythm accelerated, life is disorderly, so that the function of the organs are damaged, long will be and kidney, its collection of essence, the main water and gasification function is out of order, water does not contain wood, the liver is not draining, the spleen is not healthy, water and dampness can not be transported, accumulation of stasis, paralysis and obstruction of liver veins. Symptoms include dizziness, dizziness, soreness and weakness of the waist and knees, impotence and premature ejaculation in men and menstrual disorders in women, light red tongue and sunken pulse. The treatment is to tonify the kidneys and cultivate the vital energy, with Right Return Drink as the mainstay for kidney yang deficiency; Left Return Drink as the mainstay for kidney yin deficiency. Commonly used medicines: Shou Wu, Fructus Lycii, Fructus Chasteberry, Cordyceps Sinensis, Eucommia, Huang Jing, etc.
Phlegm and blood stasis: Deficiency of spleen and kidney is the source of dampness and lipid congestion, and phlegm clotting for a long time, blocking the meridians, can lead to blood stasis. Modern pharmacological research shows that high blood lipids are often accompanied by blood rheology changes, and phlegm stagnation can lead to lipid abnormalities in blood, which is a pathological product and a pathogenic factor. The deposition of lipids indicates the abnormality of the liver’s drainage. It is common to see pain and distension in the ribs, or stuffiness and swelling, body heat, and dullness. The tongue is dark red with thin and greasy coating, and the pulse is smooth or sunken. The treatment is to eliminate phlegm and drain water, activate blood circulation and resolve blood stasis. Often used to add and subtract from lost smile, warm gall bladder soup, Xuefu and expel blood stasis soup, commonly used drugs, Scutellaria baicalensis, Chen Pi, Semen, Atractylodes, Yin Chen, Ze Di, Hawthorn, slippery stone, Fu Ling, Dan Shen, Red Peony, Yu Jin, etc.
Liver and gallbladder qi stagnation type: the liver is the main drainage, secretion of bile, stored in the bile, for digestion of fat. According to modern medical research, the liver is also the site of lipid metabolism (synthesis, decomposition, transformation). If the liver loses its drainage, dampness and turbidity will be generated, and qi will be obstructed, and if the qi and blood are stagnant, the lipids will be difficult to be eliminated. Symptoms include dullness and distension, dry throat and bitter mouth, occasional tai-hui, depression, lack of appetite and food. The tongue is pale, with thin white or white greasy coating and thin or slippery pulse. Chai Hu Dredging Liver San, Yue Ju Wan, and Wenzhi Tang are often used for addition and reduction. Commonly used drugs, Chai Hu, Xiang Xiang, Chuanxiong, Atractylodes, Gardenia, Angelica, Peppermint, Yu Jin, etc.
The formation of fatty liver is closely related to the excessive consumption of alcohol and fatty food. The symptoms include distension and fullness of the stomach and abdomen, poor appetite, vomiting and boredom, constipation or unpleasant stools. Some patients also have severe facial acne or a dirty and dark complexion, which are caused by the actual evil of stasis and toxicity. Commonly used are Fangfengtongsheng San, Angelica Aloe Vera Pill, Hovenia Conduit Pill, and Da and Xiao Chengqi Tang with addition and reduction. Commonly used medicines are Rhizoma Rheum, Radix et Rhizoma Pinelliae, Sophora japonicae, and Radix tigrinus.