I. Diagnosis
The diagnosis of non-alcoholic fatty liver disease requires the following 3 conditions.
1. No history of alcohol consumption or consumption of alcohol containing less than 140g of ethanol per week (<70g for women).
2.Excluding viral hepatitis, drug-related liver disease, total parenteral nutrition, hepatomegaly and other specific diseases that can lead to fatty liver.
3. Histological changes on liver biopsy meet the pathological diagnostic criteria of fatty liver disease.
Differential diagnosis
Alcoholic liver disease, chronic hepatitis C, autoimmune liver disease, hepatomegaly and other specific diseases that can lead to fatty liver should be excluded; drugs (tamoxifen, amiodarone, methotrexate, glucocorticoids), total parenteral nutrition, inflammatory bowel disease, hypothyroidism, Cushing’s syndrome, lack of beta lipoproteinemia and fatty liver associated with congenital insulin resistance syndrome should also be excluded.
III. Treatment
1.Basic treatment
Formulate reasonable energy intake and diet 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.Lose weight
All patients with overweight, visceral obesity and non-alcoholic fatty liver disease with rapid weight gain in a short period of time need to control their weight and reduce their waist circumference through lifestyle changes.
4.Insulin sensitizer
Patients with combined type 2 diabetes, impaired glucose tolerance, increased fasting glucose and visceral obesity can consider applying metformin and thiazolidinediones in order to improve insulin resistance and control blood glucose.
5.Lipid-lowering drugs
Those with dyslipidemia who still present mixed hyperlipidemia or hyperlipidemia combined with more than 2 risk factors after more than 3-6 months of basic treatment and application of weight loss and hypoglycemic drugs need to consider the addition of lipid-lowering drugs such as beta, statin or probucol.
6.Drugs for liver disease
In cases of non-alcoholic fatty liver disease with abnormal liver function, metabolic syndrome, ineffective after 3-6 months of basic treatment, and those with NASH confirmed by liver biopsy and chronic progressive course of the disease, adjuvant therapy with drugs for liver disease can be used to antioxidant, anti-inflammatory and anti-fibrosis. However, multiple drugs should not be applied simultaneously.