What should I do if I find fatty liver?

Author: Deng Jiang, Li Lu, Shi Haitao Source: Science New Life

What should I do if I find fatty liver?

With the improvement of material living standards, the increase of work pressure and the increase of residents' awareness of physical examination, the prevalence and detection rate of fatty liver disease have increased significantly. Recent sampling surveys based on urban populations have shown that the prevalence of fatty liver in Chinese adults ranges from 12.5% ​​to 35.4%. It is expected that the prevalence of fatty liver in China will increase, which will cause trouble to the lives and health of many people.

So, what should you do if you discover you have fatty liver?

Correct understanding of fatty liver

Normal liver lipid content accounts for 2% to 4% of liver wet weight, with phospholipid content being the largest, and the rest being cholesterol, free fatty acids and triglycerides, etc. When the liver lipid content is greater than 5% of liver wet weight or when more than 1/3 of the liver cells per unit area undergo fatty changes under a microscope, fatty liver can be diagnosed.

When the body develops fatty liver, triglycerides in liver cells increase significantly, while in a few special types of fatty liver, cholesterol increases significantly. Fatty liver is a general term for a class of diseases, including simple hepatic steatosis, fatty liver hepatitis and its related cirrhosis and liver cancer. This disease is a clinical pathological syndrome caused by the combined effects of genetic factors, environmental factors and metabolic factors.

Most fatty livers are generally in the early stages and can be completely reversed with early treatment. There is no need to panic, just find a professional doctor for active treatment. If not treated in time, simple fatty liver may progress to fatty hepatitis and its related cirrhosis and liver cancer, and will also increase the risk of type 2 diabetes, cardiovascular and cerebrovascular events, and colorectal cancer. Cardiovascular events are the main cause of death in patients with fatty liver. Therefore, the harm of fatty liver cannot be ignored and allowed to develop.

There are many causes of fatty liver, including alcoholic fatty liver, diabetic fatty liver, gestational fatty liver, obesity fatty liver, drug-induced fatty liver, malnutrition-induced fatty liver, rapid weight loss-induced fatty liver, etc. Fatty liver can be a single cause or the result of multiple causes. Therefore, eliminating the cause is an important measure to treat fatty liver.

Improve relevant inspections

After fatty liver is discovered, relevant examinations should be completed. The first is ultrasound examination, which is cheap, easy to use, non-invasive and radiation-free. It is the most common method for detecting fatty liver. However, it cannot quantitatively detect the fat content in the liver. In addition to ultrasound examination, liver transient elastic imaging technology can also be combined to quantitatively detect the fat content in the liver in order to clarify the condition and follow-up treatment in the future.

Since fatty liver is not a single disease, but a manifestation of metabolic syndrome affecting the liver, if you have fatty liver, you should also complete the testing of metabolic syndrome components such as body mass index, body fat analysis, fasting blood sugar, postprandial blood sugar, blood lipids, blood uric acid and blood pressure, and treat the symptoms.

Dietary modification is the first-line treatment

The first-line treatment for fatty liver is to improve lifestyle by adjusting diet. Adjusting diet mainly includes limiting the total amount of calorie intake, improving dietary structure and adjusting eating rhythm. Representative methods include calorie restriction, Mediterranean diet and intermittent fasting.

Excessive total calorie intake is one of the important factors that promote the occurrence of fatty liver. Calorie restriction is one of the most common ways of dietary adjustment. It mainly limits the total calorie intake and does not make too many requirements on the dietary structure and eating time. Although calorie restriction can control body weight, there are problems such as difficulty in calorie calculation and poor compliance. Although the total calorie intake of some patients does not exceed the standard, they have problems such as irregular eating and unreasonable dietary structure, which reduces the effect of calorie restriction.

Dietary structure is closely related to the occurrence of fatty liver. The typical characteristics of a Western diet are the intake of large amounts of fat, red meat, processed meat, refined grains, and sugary drinks, which increase the risk of metabolic diseases such as obesity, type 2 diabetes, and fatty liver, as well as the risk of tumors. Therefore, a diet low in free sugars, refined carbohydrates, and saturated fatty acids, such as the Mediterranean diet and my country's Jiangnan diet, can be used to prevent and treat fatty liver.

Irregular eating can also promote the occurrence of fatty liver, including eating at inappropriate times and eating for too long. Intermittent fasting, also known as light fasting, refers to periodically not eating or taking in small amounts of food. It is an ancient and popular diet therapy, usually fasting for more than 12 hours. Unlike calorie restriction, intermittent fasting mainly emphasizes the limitation of eating time, resetting the disordered eating rhythm, and then improving the metabolic rhythm and the body's biological clock. It is more convenient and conducive to promotion. Intermittent fasting includes many plans. Common intermittent fasting plans mainly include "5:2" light fasting, fasting every other day and time-restricted eating.

Combining aerobic and resistance exercise

Sitting for long periods of time and lack of exercise are not only risk factors for fatty liver, but also risk factors for many diseases such as type 2 diabetes, hypertension, hyperlipidemia and lumbar disc herniation. Exercise can bring many benefits to the body, accelerating the body's sugar and lipid metabolism, increasing muscle density and strength, improving insulin resistance and sarcopenia, and preventing and treating obesity, type 2 diabetes, fatty liver and other metabolic diseases.

Common forms of exercise include aerobic exercise and resistance exercise. Aerobic exercise refers to exercise performed by the human body with adequate oxygen supply, which mainly relies on aerobic energy metabolism. Aerobic exercise is characterized by rhythm, low intensity, and long duration. It can enhance the endurance of the heart and lungs and is mainly beneficial to the body's circulation and metabolism. Common aerobic exercises include running, cycling, and swimming.

Resistance exercise refers to the movement of muscles when overcoming external resistance. It is a kind of strength training. This method uses resistance to promote muscle contraction, increase muscle explosiveness and muscle volume, and is beneficial to skeletal muscles. Common resistance exercises mainly include push-ups, dumbbell weightlifting and sit-ups.

The two can be combined for better fat loss results.

Patients can choose appropriate exercise according to their physical conditions and personal interests to prevent and treat fatty liver. Aerobic exercise is one of the most popular forms of exercise. Patients can perform moderate aerobic exercise 5 times a week for 30 minutes each time, or high-intensity aerobic exercise 3 times a week for 20 minutes each time, and perform resistance training 2 times a week for 8 to 10 groups. Young and middle-aged people can do jogging, mountain climbing, playing ball and other sports, while the elderly can do Tai Chi, swimming and cycling.

Drug treatment

When diet and exercise treatments are ineffective, drugs can also be used to treat fatty liver. After 3 to 6 months of improving diet and increasing exercise, patients whose weight and metabolic risk factors are still not well controlled can seek medical advice and use metformin, pioglitazone and other corresponding drugs to treat obesity, type 2 diabetes, dyslipidemia and hypertension. ■

(Author’s unit: Department of Gastroenterology, The Second Affiliated Hospital of Xi’an Jiaotong University)