Nonalcoholic fatty liver on the rise… Obesity, diabetes, and hyperlipidemia patients ‘risk’

Fatty liver symptoms and management

20% alcohol… 80% alcohol free
As visceral fat increases, the risk up to 2.2 times ↑
More than 1 in 4 people have steatohepatitis

Detected through screening in most cases without major symptoms
Weight loss through diet and exercise is important
Rapid weight loss with fasting worsens the condition
“Reduce the intake of carbohydrate-rich rice and bread”

In the new year, many people make a ‘healthy decision’ by looking at last year’s health checkup list. However, there are some items that are particularly easy to overlook. That’s fatty liver. Fatty liver refers to a condition in which fat exceeds 5% of the total weight of the liver, and it is so common that it is estimated that one in three Korean adults has it.

In particular, non-drinkers are often overlooked. However, 80% of fatty liver is caused by lifestyle regardless of drinking. Fatty liver caused by alcohol accounts for only 20%. Experts point out that management is necessary as more than 1 in 4 of these nonalcoholic fatty liver patients lead to steatohepatitis.

◆Non-alcoholic fatty liver on the rise… Beware of abdominal obesity

According to the Health Insurance Review and Assessment Service statistics, the number of alcoholic fatty liver patients decreased from 35,609 in 2016 to 27,035 in 2020, while the number of nonalcoholic fatty liver patients increased from 36,305 in 2016 to 107,327 in 2019.

The cause of nonalcoholic fatty liver is not clearly defined. It is known that a large amount of excess fat is transported to the liver from other parts of the body, or a large amount of triglycerides accumulates in the liver due to a disorder in the fat metabolism process in the liver.

Professor Kim Hyung-jun of the Department of Gastroenterology at Chung-Ang University Hospital said, “Non-alcoholic fatty liver occurs in association with diabetes, hyperlipidemia, and obesity. However, in reality, there are many cases of fatty liver even in non-obese cases, and abdominal fat, that is, visceral fat, is the greater cause of fatty liver.”

In a study that followed-up people who had undergone a domestic health checkup, it was found that the risk of nonalcoholic fatty liver increased by up to 2.2 times as the amount of visceral fat increased.

Most nonalcoholic fatty liver is simple fatty liver in which only intrahepatic deposition occurs, but in some cases, nonalcoholic steatohepatitis accompanied by inflammatory symptoms due to hepatocyte necrosis.

Nonalcoholic fatty liver disease is accompanied by 60-80% of obese people, 25-40% of fatty liver patients progress to steatohepatitis, and 5-18% of steatohepatitis patients progress to cirrhosis.

As such nonalcoholic fatty liver disease is associated with metabolic syndrome and diabetes, patients with nonalcoholic fatty liver should be cautious not only of worsening liver function but also diabetes and cardiovascular disease.

Controlling speed is also important for diet

Fatty liver has no major symptoms. Symptoms such as fatigue, general malaise, and discomfort in the upper right part of the abdomen are very rare, and most are detected by looking at an increase in the liver levels (ALT, AST) during a health check-up.

Experts recommend weight loss through diet and exercise rather than drug treatment for the treatment of nonalcoholic fatty liver. Among diabetes drugs, drugs that improve insulin resistance and antioxidants (vitamin E) are sometimes used for drug treatment, but as long-term therapeutic effects are not clear, it is important to control obesity and hyperlipidemia, which are the causes.

However, rapid weight loss, such as fasting, does not help. This is because the rapid movement of fatty acids from visceral fat to the liver can lead to acute steatohepatitis and, in severe cases, liver failure.

Appropriate weight loss is about 0.5 to 1 kg per week. It is good to start with a diet that is less than 500-1000 kcal from the calories required to maintain the current weight. This means avoiding high-calorie foods such as candy, honey, chocolate, ramen, donuts, cakes, ham, cola, and cider. Fat intake should be less than 30% of total calories, and saturated fatty acid intake, which is abundant in animal foods such as meat and dairy products, should be reduced.

Professor Jo Su-hyeon of the Department of Family Medicine at Chung-Ang University Hospital said, “In the case of non-alcoholic fatty liver, reduction of visceral fat is more important than absolute weight loss. Foods containing a lot of carbohydrates, such as rice, rice cakes, and bread, are easily converted into fat in the body, so it is better to reduce intake. On the other hand, foods containing a lot of unsaturated fatty acids such as mackerel and mackerel are effective in controlling fat deposition, such as reducing triglycerides, lowering blood sugar, and improving liver levels, so it is better to consume them sufficiently.”

Along with a healthy diet, you should also do aerobic exercise such as jogging, biking, and swimming for about 30 minutes every day.

Professor Jo Su-hyeon said, “If you lose at least 5% of your body weight, you can improve liver levels, and if you reduce about 10%, you can improve fatty liver. It’s good,” he advised.

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