Can “fatty liver” cause “hepatitis”?

This is the 4630th article of Da Yi Xiao Hu

Many young and middle-aged people accidentally discovered that their liver function tests showed elevated aspartate aminotransferase (AST) and alanine aminotransferase (ALT), and they were puzzled: "I have never had hepatitis, so why is my liver function abnormal?" He quickly checked the relevant items to find the cause of the elevated transaminase, and finally found that the cause was "hepatitis" caused by his "fatty liver."

Is “fatty liver” “hepatitis”?

Fatty liver is not viral hepatitis, but it can cause liver inflammation. We know that fatty degeneration often occurs in organs with high metabolism and high oxygen consumption, such as the liver, heart, and kidneys. The liver is the most common, because the liver is an important site for fat metabolism, which can induce fatty liver inflammation.

In case of fatty degeneration of the liver, the liver is enlarged, with blunt edges, pale yellow color, softness, and greasy feeling on the cut surface. Microscopically, the nucleus of the liver cells with severe fatty degeneration is pressed to one side by the fat accumulated in the cytoplasm, resembling fat cells, and can fuse with each other into fat cysts of varying sizes. The liver cells with severe fatty degeneration may be necrotic and develop secondary cirrhosis.

Fatty liver can be divided into alcoholic fatty liver disease (AFLD) and non-alcoholic fatty liver disease (NAFLD) according to whether alcohol is consumed. Obesity, hyperlipidemia, hyperglycemia and other factors are closely related to the occurrence of NAFLD. In my country, with the changes in people's living habits and dietary structure, people's unreasonable intake of high-fat, high-protein diets has caused the prevalence of NAFLD to reach 6.3% to 27%, gradually replacing chronic hepatitis B as the largest chronic liver disease in my country. Fatty hepatitis has now become a more common chronic hepatitis among modern people.

NAFLD can be divided into three stages: simple fatty liver, non-alcoholic steatohepatitis (NASH) with hepatocellular damage and inflammatory cell infiltration, and liver fibrosis or cirrhosis. Currently, about 20% of the world's population is at risk of NAFLD, which is a major risk factor for diabetes and one of the risk factors for the progression of chronic liver disease to liver cancer. Existing studies have shown that the immune response in patients with fatty liver is activated, leading to persistent chronic liver inflammation, and ultimately causing irreversible pathological changes such as hepatocellular damage, liver fibrosis and cirrhosis. The presence of fatty hepatitis indicates that the function of organelles in liver cells has been affected, and clinically patients will experience discomfort such as stuffiness in the liver area.

What are the dangers of fatty liver?

Many people do not take fatty liver seriously and believe that it does not require treatment. In fact, chronic fatty liver disease can also lead to serious liver damage, which can develop into cirrhosis and liver cancer if it persists for many years.

Normal human liver tissue contains a small amount of fat, such as triglycerides, cholesterol, phospholipids, glycolipids, etc. Fat content exceeding 5% is mild fatty liver, more than 10% is moderate fatty liver, more than 25% is severe fatty liver, and the fat content of severe fatty liver can even reach 40% to 50%, and some are more than 60%. Mild fatty liver disease is manifested as fatty degeneration of the liver under B-ultrasound, but there is no liver function damage, obvious liver inflammation and fibrosis. Generally, no drug treatment is required. By reducing the intake of fatty foods and losing weight, the condition of most patients is reversible. If the disease progresses further, fatty liver can cause fatty hepatitis, which is manifested as liver function damage and elevated transaminases. Pathology shows liver inflammation and necrosis, and even fatty liver fibrosis and fatty liver cirrhosis. Patients may show symptoms such as indigestion, abdominal distension, and pain in the ribs. In severe cases, nausea and other symptoms may occur. It should be taken seriously and actively intervened by drugs and diet to lose weight.

What are the common causes of fatty liver?

1. Unreasonable dietary structure: such as high-fat, high-sugar, high-calorie diet, skipping breakfast, frequent late-night snacks and other bad eating habits.

2. Excessive drinking.

3. A sedentary lifestyle: long-term desk work and lack of physical exercise and activities.

4. People with a family history of obesity, diabetes, coronary heart disease and fatty liver should pay more attention.

What should I do if I find out that I have fatty liver?

1. First of all, we must find out the cause and take targeted measures: for example, people with overnutrition and obesity should strictly control their diet; long-term heavy drinkers should quit drinking; change their sedentary lifestyle and do physical exercise; diabetics should actively and effectively control blood sugar; patients with malnutrition-induced fatty liver should appropriately increase nutrition, especially protein and vitamin intake.

2. Adjust the diet structure: do not eat or eat less animal fat and sweets (including sugary drinks); eat more vegetables, fruits and foods rich in fiber, as well as high-protein lean meat, river fish, soy products, etc. Do not eat snacks and do not have extra meals before going to bed.

3. If NASH symptoms such as elevated transaminase occur, drug intervention such as enzyme-lowering and liver-protecting drugs should be carried out under the guidance of a doctor, and attention should be paid to monitoring blood lipid and blood sugar levels in the body.

How to prevent fatty liver?

1. Eat more vegetables and fruits and stop drinking alcohol.

2. Arrange three meals a day reasonably to achieve a nutritional balance between coarse and fine foods; sufficient protein can remove fat from the liver; control carbohydrates, and avoid foods rich in monosaccharides and disaccharides, such as high-sugar cakes, ice cream, candy, etc.

3. Strengthen physical exercise and avoid long-term sitting habits.

4. The liver is the chemical factory of the human body. Any drug that enters the body must be detoxified by the liver. Don’t take medicine at will. For patients with symptomatic fatty liver, you must be cautious when choosing drugs to prevent the toxic side effects of drugs.

5. Ensuring adequate sleep, keeping your body and mind comfortable, and learning to control your emotions can also help to nourish and protect the liver.

Author: Shanghai Fifth People's Hospital Affiliated to Fudan University

Zhang Xuemin