Classification and definition of fatty liver: According to the relationship with alcohol consumption, fatty liver can be divided into two categories: alcoholic fatty liver and non-alcoholic fatty liver.
(1) Alcoholic fatty liver: alcoholic fatty liver is classified as alcoholic liver disease
It is a liver disease caused by long-term heavy alcohol consumption. Initially, it usually manifests as fatty liver, which can develop into alcoholic hepatitis, liver fibrosis and cirrhosis; in severe alcohol abuse, it can lead to extensive hepatocellular necrosis and even liver failure. A history of long-term alcohol consumption, usually more than 5 years, with an ethanol equivalent of ≥ 40g/d for men and ≥ 20g/d for women, or a history of heavy drinking within 2 weeks, with an ethanol equivalent of > 80g/d. Ethanol conversion formula: g = amount of alcohol consumed (m1) × ethanol content (%) × 0.8.
Diagnostic criteria for alcoholic fatty liver: imaging diagnosis meets the criteria for fatty liver, and serum ALT, AST or GGT may be slightly abnormal. Clinical symptoms are non-specific, may be asymptomatic, or may include right upper abdominal distension and pain, loss of appetite, fatigue, weight loss, jaundice, etc.; as the condition worsens, there may be neuropsychiatric symptoms and manifestations such as spider nevus and liver palm.
(2) Non-alcoholic fatty liver is a metabolic stress liver injury closely related to insulin resistance and genetic susceptibility
Its pathological changes are similar to those of alcoholic liver disease, but patients do not have a history of excessive alcohol consumption. The disease spectrum includes non-alcoholic simple fatty liver, non-alcoholic steatohepatitis and its associated cirrhosis and hepatocellular carcinoma. Risk factors for NAFLD include:
High-fat, high-calorie dietary structure, sedentary lifestyle, insulin resistance, metabolic syndrome and its components (obesity, hypertension, dyslipidemia and type 2 diabetes).
Clinical diagnosis: The following 3 conditions must be met:
(1) No history of alcohol consumption or consumption of less than 40 g/d (< 20 g/d in women) of alcohol equivalent;
( 2) Excluding viral hepatitis, drug-related liver disease, total parenteral nutrition, hepatomegaly, autoimmune liver disease and other specific diseases that can lead to fatty liver;
( 3) imaging and/or histological changes on liver biopsy meet the pathological diagnostic criteria for fatty liver disease.
Prevention and treatment of fatty liver.
(1) The principles of treatment for alcoholic fatty liver are: abstinence from alcohol and nutritional support to reduce the
severity of alcoholic liver disease; improvement of pre-existing secondary malnutrition and symptomatic treatment of alcoholic cirrhosis and its complications. Abstinence from alcohol is the most important measure for the treatment of alcoholic liver disease, and attention should be paid to the prevention and treatment of withdrawal syndrome in the process of abstinence from alcohol. Nutritional support: Patients with alcoholic liver disease need good nutritional support. A high-protein, low-fat diet should be provided on the basis of abstinence from alcohol, and attention should be paid to the supplementation of vitamin B, vitamin C, vitamin K and folic acid.
(2) Health promotion and education for non-alcoholic fatty liver disease, change of lifestyle, change of diet components, recommendation of low sugar and low fat
We recommend a balanced diet with low sugar and low fat, reduced intake of sucrose-containing beverages, saturated fat and trans fat, and increased dietary fiber content; moderate aerobic exercise, at least 4 times a week with a total exercise time of at least 150 min; control body mass and reduce waist circumference; control diabetes and correct metabolic disorders; treat metabolic risk factors and their comorbidities with relevant drugs according to clinical needs; strictly prohibit excessive alcohol consumption; take liver-protective antibiotics when necessary under the guidance of a physician. If necessary, take hepatoprotective and anti-inflammatory drugs to prevent hepatitis and fibrosis under the guidance of physicians.
Misconceptions about fatty liver.
(1) Fatty liver is irreversible: Fatty liver is not irreversible, pure fatty liver is the early manifestation of various kinds of liver injury, as long as early diagnosis, timely removal of the causative factors and effective treatment of the primary disease, fatty deposits in the liver can completely subside. Therefore, it is essential to screen for fatty liver-related diseases (e.g., ultrasonography) and provide early treatment to those who have causes or etiologies of fatty liver.
(2) Fatty liver is not a disease: It is wrong to believe that fatty liver is at best a suboptimal state, not a disease, and does not require treatment at all. In fact, the onset of fatty liver indicates liver cell damage, which, if allowed to progress, can lead to hepatitis and even liver fibrosis or cirrhosis.
(3) Fatty liver must be treated with lipid-lowering drugs: Although high blood lipids and fatty liver are closely related, they are usually not causally related. Recent studies have shown that some lipid-lowering drugs can concentrate lipids in the liver for catabolism, causing large amounts of lipids to accumulate in the liver and damage it. These lipid-lowering drugs do not reduce fatty liver, but rather aggravate liver damage.
(4) Eat vegetarian, do not eat fatty meat will not fatty liver: liver has a variety of functions, excessive intake of protein and starch can cause fatty liver. However, strict restriction of fat and other nutrients can lead to calorie deficiency and malnutrition, resulting in fatty liver. Therefore, a balanced diet is the best way to prevent and treat nutritional fatty liver.
(5) obese fatty liver eat more fruit is beneficial, the faster weight loss is better: the health effects of fruit is not the more the better, because fruit contains certain sugars, long-term excessive consumption can lead to increased blood sugar, blood lipids, and even induce fatty liver. For obese patients, weight reduction should be gradual, research shows that weight loss of 5kg per month will aggravate liver damage.
(6) Fatty liver aminotransferase increase is contagious, can not be more active, need to be treated with drugs: non-viral hepatitis fatty liver aminotransferase increase is not contagious. The mild increase of transaminases in non-alcoholic fatty liver or hepatitis does not need rest and nutrition, but need to strengthen exercise. Obese fatty liver aminotransferase is usually not treated with medication, and weight loss is very effective. Even if the fatty liver is accompanied by chronic viral hepatitis, weight loss should be the first consideration in obese patients, because this type of fatty liver is often not caused by viruses; in addition, the success rate of antiviral therapy is greatly reduced when combined with fatty liver.
As we can see from the principles of fatty liver treatment, most fatty liver does not require special medication except for the treatment of the primary disease. The most effective way to control fatty liver is to eat less, move more, not (less) drink alcohol, and use drugs carefully after the problem of food and clothing is solved.