Overview of fatty liver
Fatty liver is a common clinical phenomenon rather than a separate disease. Its clinical manifestations are asymptomatic in mild cases and aggressive in severe cases. Generally speaking, fatty liver is a reversible disease, and early diagnosis and timely treatment can often restore normalcy. The total amount of fat in the liver of a normal person is about 5% of the liver weight and contains phospholipids, triglycerides, lipids, cholesterol and cholesterol lipids.
The amount of fat over 5% is mild fatty liver, over 10% is moderate fatty liver and over 25% is severe fatty liver. When the total fat in the liver exceeds 30%, it can only be detected by ultrasound and diagnosed as “fatty liver” by ultrasound. In patients with fatty liver, the total lipid content can reach 40%-50%, and in some cases more than 60%, mainly triglycerides and fatty acids, while phospholipids, cholesterol and cholesterol lipids are only slightly increased.
Etiology of fatty liver
Diffuse hepatic steatosis is often zoned and is associated with many of the diseases seen clinically. In developed countries, alcoholism, obesity, and diabetes mellitus are the most common causes of large fatty droplet fatty liver. Other causes include malnutrition (especially in children with kwashiorkor disease eating a protein-deficient diet), inborn metabolic disorders (glycogen, galactose, tyrosine, or homocysteine), drugs (e.g., corticosteroids), and systemic diseases with fever. Small fat droplet type fatty liver can occur in acute fatty liver of pregnancy, Rey syndrome, some hepatotoxic drugs (valproic acid, tetracycline, salicylates) and inborn metabolic defects (e.g. urea cycle enzyme deficiency or impaired oxidation of FFA in mitochondria.
Focal fatty liver is rare and not well understood. This steatosis is nodular in nature and is often located under the liver envelope. On ultrasound or CT, it appears as multiple occupying characteristic lesions. This focal steatosis is common in patients with obesity or alcoholic liver disease.
Pathology of fatty liver
When lipid accumulation is evident, the liver is enlarged to the naked eye with a smooth and pale surface. Microscopically, the overall structure of the liver may be normal. Triglycerides are deposited and fuse with each other to form large lipid droplets that push the nucleus to the periphery. In typical cases, such as alcoholic steatosis, the hepatocytes are filled with fat vacuoles that push the nuclei to the periphery, and the hepatocytes look like large fat cells. In small lipid droplet steatosis, small lipid droplets are seen in the endoplasmic reticulum and unfused secondary lysosomes, and the hepatocytes have a foamy cytoplasm with a centrally located nucleus.
Classification of fatty liver
Obese fatty liver: The degree of fat accumulation in the liver is proportional to body weight, and the rate of fatty liver degeneration is as high as 61%-94% in severe obese people; after the weight of obese people is controlled, their fat infiltration also decreases or disappears. The treatment of this type of fatty liver should be based on adjusting the diet, the basic principle is “an appropriate two low”, that is, moderate protein, low sugar and low fat, usually pay attention to light diet, not too full, eat more fresh vegetables and fruits, limit the intake of calories. At the same time, we should strengthen exercise and actively lose weight, as long as the weight is reduced, the fat infiltration in the liver is obviously improved.
Alcoholic fatty liver: According to the liver puncture biopsy of long-term alcoholics, 75%-95% have fatty infiltration. It has also been observed that the incidence of alcoholic fatty liver increases 5-25 times when drinking more than 80-160 grams of alcohol per day. After drinking alcohol, ethanol replaces fatty acids, causing fatty acids to accumulate and ketone bodies to accumulate in the body. This leads to hypoglycemia, and in some cases, sudden death. The development of this type of fatty liver is more dangerous, but mild alcoholic fatty liver can be reduced to normal transaminase levels after 4-6 weeks of quitting smoking and drinking.
Malnutrition fatty liver: Malnutrition lack of protein is an important cause of fatty liver, mostly due to insufficient food intake or digestive disorders, which can not synthesize apolipoproteins, resulting in the accumulation of triglycerides in the liver, forming a fatty liver. If a patient with severe nutritional deficiency shows protein-deficient edema, weight loss, skin pigmentation and fatty liver, the fat in the liver is quickly reduced after a high protein diet is given; or the fatty liver is rapidly eliminated after the input of amino acids, as protein synthesis returns to normal.
Diabetic fatty liver: an average of 50% of diabetic patients can occur fatty liver, of which the adult patients are more. Because 50%-80% of adult diabetic patients are obese, their plasma insulin levels and plasma fatty acids increased, fatty liver changes both with the degree of obesity, but also with eating too much fat or sugar related. These patients on the one hand actively take the etiological treatment, on the other hand require low sugar, low fat, low calorie and high protein diet, patient fat calories accounted for less than 25% of the total calories is appropriate.
Classification of fatty liver
Fatty liver in pregnancy: Most of the cases develop at 34-40 weeks of gestation in the first child, with severe disease and poor prognosis, with maternal and infant mortality rates of 80% and 70% respectively. The clinical manifestations are severe vomiting, jaundice and abdominal pain, which are difficult to distinguish from fulminant viral hepatitis. The disease can be reversed by timely termination of pregnancy, and a few can be rescued by natural delivery or cesarean section.
Drug-induced fatty liver: Certain drugs or chemical toxins cause fatty liver by inhibiting protein synthesis, chemical drugs, western drugs such as tetracycline, adrenocorticotropic hormone, puromycin, puromycin, and arsenic, lead, silver, mercury, etc. Such fatty liver should be discontinued immediately, supplemented with supportive therapy if necessary, until the fatty liver recovers.
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 in patients with viral hepatitis if they excessively restrict their activities and consume a high sugar and high calorie diet; fatty liver is more likely to occur after receiving corticosteroid treatment. The fatty liver improves rapidly after controlling the infection or removing the cause, and there are also the so-called extra-gastrointestinal hypertrophic fatty liver, toxic fatty liver, and fatty liver caused by hereditary diseases. Fatty liver is a pathological phenomenon that does not need to be treated as a separate disease and is by no means without a cure. When you find out that you have fatty liver, you should go to the hospital as early as possible for serious examination to find out the cause of the disease and treat the cause, most of the fatty liver can be restored to normal!
Fatty liver can be divided into obesity, over-eating fatty liver, post-hepatitis fatty liver, alcoholic fatty liver, nutritional deficiency fatty liver, drug fatty liver, diabetic fatty liver, pregnancy fatty liver and unexplained cryptogenic fatty liver according to different physical qualities and different dietary habits that lead to different pathogenesis of fatty liver.
Fatty liver is divided into mild fatty liver, moderate fatty liver and severe fatty liver according to its severity. Mild fatty liver has become a common problem for modern people. Mild fatty liver is the best time to treat fatty liver.
Degree of fatty liver lesions
The classification is based on the degree of histopathological changes in the liver, and there are four general conditions as follows
1. Simple fatty liver: the lesions of the liver are only manifested as fatty degeneration of the hepatocytes. Fatty liver is classified according to the extent of hepatocyte steatosis into diffuse fatty liver, focal fatty liver, and diffuse fatty liver with normal liver islets.
2.Steatohepatitis: It refers to the inflammation of hepatocytes that occurs on the basis of hepatocyte steatosis. According to statistics, this condition occurs in about 40% of cases with long-term heavy alcohol consumption, while steatohepatitis generally rarely occurs in non-alcoholic fatty liver.
3, fatty liver fibrosis: refers to the fibrotic changes that have occurred around the liver cells. The degree of fibrosis is related to the persistence of the causative factors and the severity of the fatty liver. Alcoholic liver fibrosis can occur on the basis of simple fatty liver, while non-alcoholic occurs on the basis of steatohepatitis. If liver fibrosis continues to progress, the disease becomes fatty cirrhosis.
Fatty liver can cause five common diseases
1. Cirrhosis and liver cancer. Long-term untreated fatty liver can cause ischemic necrosis of liver cells, which can lead to liver fibrosis and cirrhosis, and other malignant liver diseases. Fatty liver patients are 150 times more likely to have cirrhosis and liver cancer than normal people.
2. Digestive system diseases.
3. Atherosclerosis and cardiovascular diseases.
4. Affects sexual function.
5. Affects vision.
Dietary treatment
Diet therapy is the basic method of treatment for most patients with fatty liver, and is also an important measure to prevent and control the progression of fatty liver disease. It is well known that the source of caloric energy is protein, fat and sugar in food, and its requirement is related to age, gender and type of work and other factors. Excessive caloric intake can lead to weight gain and increased fat synthesis, thus accelerating the steatosis of liver cells. Therefore, a reasonable diet should be developed and adhered to. Diets rich in lipophilic substances such as lean meats, fish, egg whites and fresh vegetables can help promote fat loss in the liver, and foods high in fiber can help increase satiety and control blood sugar and blood lipids, which is especially important for fatty liver caused by overnutrition.
Foods high in fiber include corn bran, couscous, brown rice, hard fruits, beans, mushrooms, kelp, fungus, duck pear, konjac, etc. At the same time, attention should be paid to adequate and reasonable drinking water, in general, adults need to drink 2,000ml of water daily, the elderly 1,500ml, obese people because the water in the body is 15% to 20% less than normal, so the daily water intake needs to be 2,200ml to 2,700ml, an average of 300ml to 500ml every 3 hours; the best choice of drinking water is plain water, mineral water, purified water and light tea The best choice of drinking water is plain water, mineral water, purified water and light tea, etc. Do not drink various kinds of drinks, milk and coffee instead of drinking water. If you have an over-nutritional fatty liver, drink water 20 minutes before meals to make your stomach feel full, which can reduce your appetite, reduce the amount of food you eat and help you lose weight.
People with fatty liver should pay attention to the reasonable combination of the three major nutrients, i.e. increase the intake of protein, pay attention to the quality and quantity of fat, and the sugar diet should be moderate, limiting the intake of monosaccharides and disaccharides. 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, and should limit the intake of cholesterol, such as animal offal, brain marrow, egg yolk, fish eggs, squid, etc. In terms of sugar intake, one should eat some low-sugar diet and not eat foods rich in monosaccharides and disaccharides, such as high-sugar pastries, ice cream, dried dates and candies.
People with fatty liver should also firmly change their bad eating habits and implement a regular three meals a day. Long-term heavy alcohol consumption can cause fatty liver and alcohol should be resolutely stopped. At the same time, excessive ingestion, snacking, night eating, intermittent eating and excessive pursuit of high-grade and high-calorie seasoned and thick food can cause excessive fat accumulation in the body and should therefore be avoided as much as possible. Irregular eating patterns, such as frequent skipping breakfast, or three meals unevenly full and hungry will disrupt the body’s metabolic dynamics, providing conditions for the onset of obesity and fatty liver. Studies have shown that with the same amount of energy intake throughout the day, it is easier to gain weight by fixing too much food in the evening than by eating in three regular meals. In addition, those who eat too fast are less likely to feel full and are more likely to develop obesity due to excessive energy intake.
Exercise treatment
Types of exercise: People with fatty liver mainly choose whole-body low-intensity dynamic exercise aimed at exercising whole-body physical strength and endurance, which is usually called aerobic exercise, such as jogging, medium and fast walking (115-125 steps/minute), cycling, going up and down stairs, climbing, playing badminton, playing shuttlecock, patting leather ball, dancing, doing radio gymnastics, jumping rope and swimming, etc. These kinds of exercises are good for people with fatty liver to lower fat These exercises are more effective in reducing fat and promoting fat loss in the liver.
Exercise intensity: people with fatty liver should choose the appropriate amount of exercise according to the degree of fatigue and heart rate (pulse) after exercise, with a pulse of 100 to 160 times/minute (170 minus the actual age) during exercise, lasting 20 to 30 minutes, and fatigue disappearing within one or 20 minutes after exercise is appropriate. 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.
Exercise implementation time band and frequency: According to research, the same exercise program and exercise intensity, afternoon or evening exercise than the morning exercise 20% more energy consumption. Therefore, the best time to choose to exercise exercise in the afternoon or evening; the best time to walk is 45 minutes after dinner, when the maximum calorie consumption, the effectiveness of weight loss is also the best. The frequency of exercise implementation to 3 to 5 days a week is more appropriate, the specific should be based on the implementation of the degree of obesity, spare time and the hobby of exercise and other factors to decide. If the fatigue after exercise does not last until the next day, exercise can be carried out every day.
Drug treatment
So far, there is no effective drug to prevent and control fatty liver. Generally, we often use hepatocyte protection, lipid removing drugs and antioxidants, such as vitamins B, C, E, lecithin, ursodeoxycholic acid, silymarin, inosine, coenzyme A, reduced glutathione, taurine, carnitine orotate, hepatic tylenol, and certain lipid-lowering drugs, etc. Although there are many drugs mentioned above, most of them still need further verification of their efficacy and safety, therefore, they should be used properly under the guidance of doctors and should not be abused.