Moderate fatty liver

　　The causes of moderate fatty liver include the following points:

　　1. Long-term alcohol abuse: Alcohol is the number one killer of liver damage.

　　2. Overnutrition: Long-term intake of excessive animal fats, vegetable oils, proteins, and carbohydrates.

　　3. Malnutrition: Obese individuals are more prone to fatty liver, but this does not mean that thin people will not get fatty liver.

　　4. Chronic diseases such as diabetes, hepatitis, hyperthyroidism, and severe anemia: Diabetic patients, due to insulin, have a fat liver rate twice as high as non-diabetic individuals.

　　5. Drug-induced liver injury: Drug-induced liver injury accounts for 1/10 of adult hepatitis, and fatty liver is a common type. Dozens of drugs are associated with fatty liver, such as tetracycline, acetylsalicylic acid, glucocorticoids, synthetic estrogens, amiodarone, nifedipine, certain antitumor drugs, and lipid-lowering drugs, all of which can lead to fat accumulation in the liver.

　　6. Hyperlipidemia High cholesterol and fatty liver are closely related, among which the relationship with high TG (triglyceride)emia is the closest. The vast majority are often accompanied by obesity, diabetes, and alcoholism. In addition, certain industrial toxins, such as phosphorus, arsenic, lead, copper, mercury, benzene, carbon tetrachloride, and so on, can also cause fatty liver. Pregnancy, heredity, or mental, psychological, and social factors, such as sedentary lifestyle, lack of activity, and laziness, are also related to the occurrence of fatty liver.

　　The common complications of moderate fatty liver include the following several types:

　　1. Other manifestations of alcohol intoxication, such as alcohol dependence, pancreatitis, peripheral neuritis, anemia glossitis, alcoholic hepatitis, liver cirrhosis, and so on.

　　2. Overnutrition fatty liver often coexists with other basic diseases, such as obesity, diabetes, hyperlipidemia, hypertension, coronary atherosclerotic heart disease (abbreviated as coronary heart disease), gout, cholelithiasis, and so on.

　　3. Nutritional deficiency fatty liver often coexists with chronic consumptive diseases such as tuberculosis and ulcerative colitis.

　　4. Acute fatty liver of pregnancy often complicates renal failure, hypoglycemia, pancreatitis, sepsis, disseminated intravascular coagulation (DIC), and so on.

　　5. Severe fatty liver patients may have ascites and lower limb edema. Other symptoms may include spider veins, gynecomastia, testicular atrophy, impotence, amenorrhea, infertility, and so on in women.

　　6. Hyperlipidemia, due to the deposition of fat in the liver, causes liver damage, a decrease in high-density lipoprotein synthesis, and a relative increase in low-density and very low-density lipoproteins, thereby causing hyperlipidemia, becoming a dangerous accomplice of heart disease and stroke. Hyperlipidemia caused by various reasons can also lead to fatty liver, forming a vicious cycle. The main symptoms include dizziness, headache, chest tightness, and so on.

　　7. Hypoglycemia, hemolytic anemia, and alcoholic hyperlipidemia syndrome are mainly seen in patients with alcoholic liver disease.

　　Typical symptoms of moderate to severe fatty liver include loss of appetite, abdominal distension, fatigue, fever, nausea, vomiting, weight loss, tenderness or percussion pain in the upper right abdomen, etc. The liver may slightly enlarge and be tender to touch, and a few patients may have splenomegaly and liver palms.

　　When there is an excessive accumulation of fat in the liver, it can cause the liver capsule to swell, the liver ligaments to be pulled, and lead to severe pain or tenderness in the upper right abdomen, percussion pain, fever, and an increase in white blood cells. These symptoms are often misdiagnosed as acute abdomen, so it is necessary to differentiate from diseases of the liver, gallbladder, and gastrointestinal system, such as acute hepatitis, chronic hepatitis, liver cirrhosis, acute and chronic gastritis, etc., for an accurate diagnosis and timely symptomatic treatment.

　　As people enter middle age, their basal metabolic rate decreases, and fat accumulates around the waist faster, leading to a middle-wide figure. When a beer belly appears, the fat in the internal organs has often accumulated severely, making it a high-risk group for fatty liver disease. The health crisis brought by moderate fatty liver disease should not be ignored, so it is very important to prevent fatty liver disease.

　　Research shows that one-fifth of fatty liver patients will develop liver cirrhosis. The reason is that fatty liver affects liver metabolic function and causes inflammation of liver cells. If it continues to deteriorate, it can lead to liver fibrosis, liver cirrhosis, and even liver cancer. To reduce body fat, in addition to exercise, dietary balance is more important, and calorie intake should be controlled. Before each meal, moderate fatty liver patients should calculate the calorie content of food, and eat more fiber-rich fruits and vegetables to obtain a sense of satiety and inhibit the absorption of excessive calories, preventing excess calories from being converted into fat and stored in the liver. In addition to fiber, it is also necessary to consume antioxidant nutrients, as vitamin A, C, E, and B-group vitamins are needed in the liver metabolism process to reduce excessive oxidation of fat.

　　The following are the items of laboratory examination for moderate fatty liver:

　　Blood biochemical examination: Fatty liver, due to the compression of enlarged fat cells on the bile duct, may sometimes cause an increase in serum transaminases, beta globulin, ferritin, apoA, and bile acids. Clinical studies have found that only 20%-30% of fatty liver patients have one or more abnormal serological indicators, and they are not specific.

　　B-ultrasound examination: Due to the fat deposition in liver cells, the absorption of ultrasonic energy is significant, and scattering occurs. Therefore, the sound energy is mainly absorbed in the pre-liver area, and the sound energy in the post-liver area is significantly attenuated, making the intraluminal structural changes in the liver finer and less clear. B-ultrasound can detect fatty liver with fat content above 30%, and its sensitivity to fatty liver with fat content above 50% is 100%.

　　CT examination: Diffuse fatty liver is characterized by a general decrease in liver density compared to the spleen, kidneys, and intraluminal blood vessels. After enhancement, the intraluminal blood vessel images are very clear, and their morphological directions are all normal. The CT value is significantly negatively correlated with the amount of liver fat deposition.

　　Radioisotopes: Radioisotopes can also be used for the diagnosis of fatty liver, but they lack specificity. It is noteworthy that focal fatty infiltration in the liver can be manifested as a localized mass on B-ultrasound examination, while radioisotopes show normal results, which is helpful for diagnosis.

　　Liver biopsy: Liver biopsy under ultrasound guidance is the main method for diagnosing fatty liver. Morphological examination requires special staining, immunohistochemistry, tissue biochemical determination, and special cytological examination, which can improve the accuracy of diagnosis.

　　Attention for diet of moderate fatty liver, such as long-term heavy drinkers should abstain from alcohol, excessive nutrition, overweight individuals should strictly control their diet to restore normal weight, individuals with fatty liver and diabetes should actively and effectively control blood sugar, and patients with malnutrition-related fatty liver should appropriately increase nutrition, especially protein and vitamin intake. In summary, removing the cause is beneficial for the cure of fatty liver.

　　In addition to the dietary注意事项 for moderate fatty liver, fatty liver patients should advocate for a diet high in protein, high in vitamins, low in sugar, and low in fat. Avoid or eat less animal fat and sweets (including sugary drinks), eat more vegetables, fruits, foods rich in fiber, and high-protein lean meat, river fish, bean products, etc. Avoid snacks and do not eat a snack before going to bed.

　　The key to the treatment of moderate fatty liver in Western medicine lies in anti-fibrosis, and commonly used drugs include retinoic acid (retinol), interferon, proline analogs, proline hydroxylase inhibitors, and colchicine, etc., which interfere with at least one or more steps in the collagen formation process. Vitamin A preparations such as retinoic acid and β-carotene have therapeutic potential. Interferon has α, β, γ three types, and it is currently believed that α and γ interferons have significant anti-fibrotic effects, with γ interferon showing the strongest anti-fibrotic effect. Therefore, the use of interferon in patients with compensatory liver cirrhosis may lead to decompensated state.

      Interferon is currently mainly used for the treatment of the active stage of chronic viral hepatitis, in order to take into account antiviral and anti-fibrosis effects, and is not recommended for use after the liver cirrhosis has developed into decompensated state; colchicine can act on different stages of the collagen cascade reaction, but large-scale clinical studies on the use of colchicine to treat liver cirrhosis patients were not successful, and it was not significantly superior to placebo in improving liver function, anti-fibrosis, and prolonging patient survival; adrenal cortical hormones can inhibit collagen synthesis and inhibit collagenase activity to promote collagen degradation, but the long-term use of these drugs has serious side effects and reduces the body's immune function, making it difficult to be recommended for clinical use in the treatment of liver fibrosis; hepatocyte growth factor can stimulate collagenase activity to promote collagen degradation, inhibit the overexpression of TGF-β gene, and inhibit apoptosis of liver cells, thereby exerting an anti-fibrotic effect. In addition, it can mobilize fat and may reduce the severity of fatty liver, but its clinical efficacy needs further verification.