FATTY LIVER

 In the current gastroenterology and hepatobiliary clinic, fatty liver disease (GNM) is quite common. Some patients are overly worried, some take it lightly, some complain that the disease is difficult to treat, some wonder how to detect it early, how to prevent it.

1/ DOCTOR, WHAT IS FATTY LIVER DISEASE?

     The liver is an organ located in our abdomen, hidden under the right rib cage. The weight of the liver varies depending on the height and weight of each person, ranging from 1.1-1.6 kg. Of which, the fat component accounts for no more than 5% of the liver's weight. When the amount of fat accumulated exceeds 5% of the liver's weight, it will lead to fatty liver disease.

2/ IS FATTY LIVER DISEASE DANGEROUS?

Depending on the cause of the disease, it can be said that GNM is really dangerous or not:

  -  Caused by alcohol: 90 % of people who drink a lot of alcohol (men drink more than 200ml of alcohol and women drink 100ml of alcohol in 5 - 10 years) have a 50% chance of developing chronic hepatitis and cirrhosis.

  -  Due to chronic hepatitis B and C , the risk of cirrhosis is high.

  -  Due to overweight, obesity, diabetes, dyslipidemia , according to previous concepts, it is considered quite benign and not dangerous. However, there is increasing evidence that non-alcoholic fatty liver disease, fat particles accumulate too much in the liver can still cause chronic hepatitis due to fatty degeneration of the liver and gradually lead to chronic hepatitis and cirrhosis in about 10%.

 In addition, women with polycystic ovaries, people who often lack sleep, snore, and lack vitamin D can still get GNM if they have abdominal fat accumulation.

 In short, although GNM is a benign disease, 1/4 of cases still progress to chronic hepatitis and cirrhosis . Chronic hepatitis due to fatty liver can lead to liver cancer even without cirrhosis complications.

3/ CAUSES OF DISEASE?

  Many people think that only obese people get fatty liver. In fact, obesity is only the most common cause of fatty liver. People who are not obese can still get fatty liver disease.

  Some causes of fatty liver can be listed in order of priority as follows:

   -  The first is people who drink alcohol (90% of people who regularly drink alcohol will have fatty liver). Alcohol limits the synthesis of lipoprotein and inhibits the excretion of fat in the liver, increasing the process of fat accumulation here. Improper distillation causes alcohol to contain many impurities such as methanol , acids and esters , which poison and weaken liver cells. Alcohol also attracts fat from adipose tissue to "run" to, and concentrate in the liver.

   -  Chronic hepatitis B, C.

  -  Being overweight, obese, having a large waistline, dyslipidemia, diabetes, and high blood pressure (commonly known as metabolic syndrome) all increase the risk of fatty liver disease. Often because we like to eat fatty, sweet foods, snack, regularly drink sugary drinks, party at night, eat late at night, and have little exercise, the liver has to work hard to turn nutrients into fat. Fat is absorbed into the blood in batches and transferred under the skin and internal organs. Because it is overloaded, the liver cannot transport it all, so it turns itself into a "warehouse" for storing fat.

   -  Using drugs that are toxic to the liver: overdose of vitamin A, drugs containing corticosteroids (found in asthma, joint and oriental medicine of unknown origin) can all cause fat accumulation in the abdomen and fatty degeneration of the liver.

   -  Malnutrition, lack of protein in the diet (lack of amino acids to transport fat away from the liver), prolonged continuous intravenous feeding or if weight loss is too rapid, more than 1kg/week, can still cause GNM.

4/ WHAT ARE THE COMMON SYMPTOMS OF FATTY LIVER DISEASE?

   -  Most patients have no symptoms because the fat deposition in the liver occurs slowly, so it is difficult for patients to feel. In fact, sitting in the clinic, we see that more than 2/3 of fatty liver cases are discovered during routine health check-ups or when examining for another disease.

   - The most common and if present symptoms are fatigue, a feeling of heaviness in the right subcostal region and can cause liver enlargement. Fatty liver can also cause jaundice, nausea and vomiting, loss of appetite but very rarely. Depending on the cause of fatty liver, there are corresponding clinical symptoms.

  In mild cases, fatty liver has no symptoms, but later causes liver dysfunction, increased blood fat affects the cardiovascular system, often causing atherosclerosis and high blood pressure, so patients with fatty liver are more likely to die from cardiovascular disease and cerebrovascular disease than those without fatty liver.

  In addition, in the long term, fatty liver disease will have the risk of causing chronic hepatitis , cirrhosis, liver cancer, ...

5/ HOW DO I KNOW IF I HAVE FATTY LIVER?

  The gold standard for diagnosing fatty liver is liver biopsy. However, this is an invasive technique so it is rarely performed. Techniques such as arfi, fibro scan, etc. cannot be performed everywhere, even in large hospitals.

  Therefore, the simplest and easiest method to screen for fatty liver disease is a general abdominal ultrasound.

6/ DOCTOR, WHEN FATTY LIVER DISEASE IS DISCOVERED, WHAT ADDITIONAL TESTS SHOULD BE DONE TO DETERMINE THE MOST APPROPRIATE TREATMENT METHOD?

   Fatty liver is caused by many factors such as alcohol, viral hepatitis , overweight, obesity, diabetes, dyslipidemia, etc. Therefore, when detecting fatty liver, we need to do some more tests depending on each patient to have appropriate treatment methods such as:

    - Blood tests to evaluate blood sugar and blood lipids to see if there is an increase in substances: cholesterol, LDL-cholesterol, triglycerides, liver function tests, liver enzymes.

    - Should I get tested to see if I am infected with hepatitis B or C virus?

   - Measure the amount of lean fat, especially visceral fat, regional fat and total body fat because this is the cause of increased risk of many diseases such as diabetes, high blood pressure, cardiovascular disease, stroke and cancer. Although there are many methods to determine the percentage of fat in the body, DEXA is considered the "gold standard" in measuring body components. DEXA Scan is a machine similar to a CT scanner but is very safe to use in adults as well as children. When performing a DEXA scan, in addition to determining the amount of visceral fat, regional fat and total body fat, we also know the bone mineral density to know if we have osteoporosis or not, know the muscle mass of each region and the whole body.

7/ WHAT ARE THE METHODS OF PREVENTING GNM DISEASE?

     - Don't drink alcohol.

     - Should be vaccinated against hepatitis A and B.

     - You should eat all 3 food groups, do not fast too much.

     - Prevent diabetes, obesity, overweight.

     - Patients should consume at least 300 grams of green vegetables every day such as lettuce, cucumber, broccoli, spinach, celery, beans, corn, tomatoes, green tea and fruits (bananas, lemons, oranges, tangerines, grapefruits, apples) which are necessary for patients because these foods also have anti-oxidant and anti-aging effects for the body.

     - Should eat lean meat, fish. Limit foods high in saturated fat and cholesterol, fast foods such as fried chicken, hamburgers, hot dogs, sausages, canned foods, animal organs, chicken, duck, pork skin, eggs, full-fat milk or butter, cheese.

     - Avoid fried dishes, replace them with boiled dishes.

     - You can eat a little dark chocolate or drink 1-2 cups of black coffee without sugar every day.

     - Do not eat foods high in sugar.

     - Consult your doctor before taking medication to avoid drugs that are toxic to the liver.

     - Regular exercise: at least 15 - 30 minutes a day and 5 days a week or playing a sport regularly is the most effective medicine to reduce blood fat, as well as improve fatty liver condition. When exercising, we will burn energy from fat tissue, the liver increases metabolism and pushes fat out of the tissue to compensate.

8/ CAN GNM BE TREATED? HOW TO TREAT GNM?

     - In case of fatty liver caused by alcohol, the only way to recover the liver is to quit drinking alcohol.

     - Treat hepatitis B and C if present and avoid liver toxins.

     - Diabetes, dyslipidemia, hypertension should be detected and treated early, and lipid-lowering drugs, blood pressure and blood sugar stabilizers, should be used as necessary for patients.

     - Weight loss in obese patients is a treatment for fatty liver but must be done slowly with a reasonable diet, appropriate medication and regular exercise.

  In short, GNM is not a dangerous disease if treated well. Patients need to be monitored and given appropriate medication by a gastroenterologist - hepatobiliary specialist. It is worth noting that GNM can be treated if the cause is known because the liver's recovery process can be prolonged, sometimes taking 1-2 years.