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For medical professionals only
Fatty liver has become the largest chronic liver disease in China, and fatty liver in children is becoming more and more common
.
Mr.
Tian, 38 years old, was diagnosed with mild fatty liver
during a physical examination five years ago.
For five years, mild fatty liver became one of the regular abnormal results in his annual medical report, neither getting heavier nor returning to normal, and he never went to the doctor
for it.
There are nearly 400 million fatty liver patients like Mr
.
Tian in China.
Professor Fan Jiangao, Director of the Department of Gastroenterology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, has been
engaged in the clinical diagnosis and treatment and research of fatty liver for nearly 30 years.
When he first engaged in fatty liver research, the incidence was only about 13%, and today, the prevalence of adult fatty liver in China has reached more than
33%.
"Even asymptomatic simple fatty liver is not a sub-health state, but a chronic epidemic non-infectious disease, at present, fatty liver has replaced viral hepatitis as the largest chronic liver disease
in China.
" Professor Fan Jiangao said, "Fatty liver can lead to hepatitis, cirrhosis, liver cancer, and liver failure
.
A patient with fatty liver is also ineligible as a donor for liver transplantation, which will further exacerbate the shortage
of liver transplant donors.
”
Professor Fan Jiangao
Not an independent disease
fatty liver is divided into alcoholic fatty liver (ALD) and non-alcoholic fatty liver (NAFLD), Professor Fan Jiangao said that 85%~90% of fatty liver in China is non-alcoholic fatty liver, and most alcoholic fatty liver is also associated with metabolic dysfunction such as obesity and diabetes, that is, mixed fatty liver
.
Like chronic diseases such as hypertension and diabetes, fatty liver is also a disease
closely related to a poor lifestyle.
The "Guidelines for the Prevention and Treatment of Fatty Liver in China (Popular Science Edition)" edited by Professor Fan Jiangao and Academician Zhuang Hui clearly pointed out that it is a bad lifestyle that gives birth to fatty liver: modern work and home environment, more sitting and less moving lifestyle, high-fat and high-calorie dietary structure, sugary drinks and snacks, often staying up late, insufficient sleep time, etc.
, are closely related
to the occurrence of non-alcoholic fatty liver.
Therefore, in many cases, fatty liver is not an unexplained or cryptogenic disease, but a pathological change in the accumulated liver by systemic diseases such as obesity, diabetes, and metabolic syndrome, and the impact of fatty liver is not limited to the liver
.
"From a metabolic point of view, fatty liver increases the risk of metabolic syndrome and type 2 diabetes, affects the glycemic control effect of diabetic patients, and increases the risk of cardiovascular disease, cerebrovascular disease, peripheral vascular disease and chronic kidney disease caused by atherosclerosis, as well as the associated complications and deaths
.
" Professor Fan Jiangao said, "In particular, liver inflammation and damage (steatohepatitis liver fibrosis), as well as fatty liver with obesity, diabetes, and metabolic syndrome, will also increase the risk
of a variety of malignant tumors.
"
In addition, fatty liver also coexists and interacts
with polycystic ovary syndrome, sleep apnea syndrome, osteoarthritis, cholelithiasis, sarcopenia, etc.
" Therefore, people with fatty liver may also have gallstones, and people with gallstones are particularly prone to liver damage, and there are cross-complex effects
between each other.
Professor Fan Jiangao pointed out that although the liver disease process in patients with nonalcoholic fatty liver disease is slow, patients usually have elevated blood pressure, blood lipids, blood sugar and uric acid before they have elevated serum transaminases; Atherosclerotic cardiovascular and cerebrovascular disease usually precedes cirrhosis; Colorectal adenoma or adenocarcinoma usually already develops before hepatocellular carcinoma develops; Even if patients with fatty liver can successfully escape the fatal threat of cardiovascular and cerebrovascular diseases and extrahepatic malignancies, they will face the risk
of cirrhosis and hepatocellular carcinoma at about the age of 70.
Mr.
Tian's physical examination report in the past five years can also confirm Professor Fan Jiangao's conclusion, in addition to mild fatty liver, his physical examination report also showed that he was overweight, high blood triglycerides and uric acid, and blood sugar was close to abnormal (prediabetes).
Although alcoholic fatty liver disease patients account for a small proportion of fatty liver patients in China, because alcohol can cause severe liver damage, patients with alcoholic fatty liver disease have a higher incidence of severe hepatitis, cirrhosis and hepatocellular carcinoma and have a faster
progression of liver disease than non-alcoholic fatty liver disease.
The most important factors affecting the onset of complications of liver disease in patients with fatty liver are excessive alcohol consumption and metabolic dysfunction
.
"Chinese Guidelines for the Prevention and Treatment of Fatty Liver (Popular Science Edition)" pointed out that in the outpatient treatment of alcoholic liver disease patients, 10%~33% have alcoholic hepatitis, about 20% of alcoholic hepatitis patients even if they quit drinking, liver disease may still continue to develop, and eventually cirrhosis, and once cirrhosis occurs, alcohol abstinence can not prevent the occurrence
of liver cancer.
People with alcoholic cirrhosis develop symptoms around the age of 50 on average and often die
around the age of 60.
In developed countries in Europe and the United States, fatty liver has been the most important reason for the rapid growth of liver cancer incidence, and it is also the reason why the number of liver transplants in these countries ranks first in the
world.
Professor Fan Jiangao said: "Regardless of whether there are symptoms or not, whether transaminases are elevated or not, whether or not it has been combined with obvious liver fibrosis, we must treat fatty liver as a chronic disease and need to intervene
as soon as possible.
" "
It should be noted that with the global epidemic of obesity, fatty liver in children is also becoming more and more common, and the prevalence of fatty liver in overweight and obese children is as high as 17
% and 50%, respectively.
"Chinese Guidelines for the Prevention and Treatment of Fatty Liver (Popular Science Edition)" recommends fatty liver screening for all obese children aged 9~11 years (median BMI ≥ 95%), because ultrasound examination lacks sufficient sensitivity and specificity, so the best recommended screening method for children with non-alcoholic fatty liver is to detect serum alanine aminotransferase (ALT) levels
.
More than half of those with elevated serum ALT (>30 IU/L for boys and 19 IU/L for girls) had fatty liver.
The above guidelines specifically suggest that without intervention, children with fatty liver will soon become hypertensive disease, diabetes, atherosclerotic cardiovascular and cerebrovascular diseases and cirrhosis
after entering adulthood.
What should I do if fatty liver is detected?
Professor Fan Jiangao said that the treatment of fatty liver is a long-term systematic project, and there is no specific drug
for the prevention and treatment of fatty liver so far.
Because patients with fatty liver often have many extrahepatic diseases, the treatment of fatty liver requires multidisciplinary cooperation, whether alcoholic fatty liver or non-alcoholic fatty liver, both are chronic diseases, even if short-term treatment is effective, it is easy to recur, so the intervention treatment of fatty liver is a long-term process
.
The "Chinese Guidelines for the Prevention and Treatment of Fatty Liver (Popular Science Edition)" makes it clear that fatty liver can be prevented and cured
.
Prevention is mainly to change bad lifestyle and modify bad behavior, including scientific and reasonable diet, mainly plant food, supplemented by animal food, avoid high-calorie, high-fat, low-fiber dietary structure, drink more tea, coffee, do not drink fructose-containing beverages, do not eat snacks, do not eat late-night snacks, and prevent excess calories from leading to obesity and metabolic disorders and their related fatty liver; quit smoking, reduce alcohol consumption or not drink alcohol at all; Thereby preventing obesity, metabolic disorders, alcohol abuse and its associated fatty liver
.
In terms of exercise, adhere to more than 150 minutes of moderate aerobic exercise per week and persevere
.
Avoid the bad habit of sitting for a long time and moving less, and usually do some impedance exercise
as much as possible.
In the "Clinical Practice Guidelines for the Diagnosis and Treatment of Nonalcoholic Fatty Liver Disease", published in the official journal Endocrine Practice of AACE in May this year, it is recommended that overweight and obese non-alcoholic fatty liver patients develop individualized weight loss plans and engage in physical activities
that improve physical condition and cardiometabolic health.
The goal of weight loss is at least 5%, preferably greater than 10%, and according to personalized risk assessment, the more weight loss, the better the liver tissue structure and cardiometabolic health
.
Because the liver is the main organ of drug metabolism, drugs are also a common cause
of liver damage and fatty liver.
Therefore, drugs should be used with caution, strictly grasp the indications when taking drugs, reasonably select the type, dose and course of drugs, follow the doctor's advice and monitor regularly, and avoid long-term self-medication
.
Regular physical examination is also very important, especially for those with obesity, diabetes, hyperlipidemia, and family history of fatty liver, regular physical examination should be adhered to in order to detect early, intervene early, and treat early, and prevent the occurrence and development
of liver fibrosis and cardiovascular disease in patients with fatty liver.
In terms of treatment, if simple fatty liver can remove the cause and cause in time, effectively treat the coexisting obesity, diabetes, blood lipid disorders, hypertension, and intrahepatic fat deposition, it can completely subside
within a few months.
Even if steatohepatitis occurs, timely lifestyle changes to lose 10% of weight and metabolize cardiovascular risk factors through related drugs, liver lesions can be completely recovered
.
Once fatty cirrhosis progresses, it is an irreversible disease, but through active intervention, it can also delay the progression of liver disease and reduce complications
.
Professor Fan Jiangao emphasized that the treatment of fatty liver is a comprehensive prevention and treatment, and lifestyle changes are as important
as the drug treatment of various chronic diseases.
Unless the problems of excess calories and alcohol abuse can be solved at the source, drugs that simply target a certain pathogenesis such as liver inflammation and fibrosis are difficult to cure fatty liver and its accompanying diseases
.
"Prevention of fatty liverThe earlier the treatment, the better the effect, and the later the more passive, the more compromised the effect, if the physician can not handle the significant increase in blood sugar, blood lipids, and blood pressure in obese patients, he can consider asking a surgeon to do metabolic bariatric surgery; If you can't get end-stage liver disease, you may need a liver transplant
.
"
Elevated serum aminotransferases are the most common reason for hospital visits in patients with fatty liver, and clinicians often treat these patients with enzyme-lowering drugs
.
However, Professor Fan Jiangao said that most patients with fatty liver with elevated serum transaminases do not need to use enzyme-lowering drugs, because although such drugs can rapidly reduce serum transaminase levels, they have little protective effect on the liver, and can not remove liver fat deposits.
In addition, it is easy to cover up the truth of the disease after rapid enzyme reduction, so that some patients ignore basic treatments
such as smoking cessation, alcohol restriction, dieting, and exercise.
For non-alcoholic fatty liver disease in children, North America specially formulated the "Guidelines for the Diagnosis and Treatment of Nonalcoholic Fatty Liver Disease in Children"
in 2017.
Children's fatty liver is mainly based on lifestyle intervention, if necessary, you can use metformin, glucagon-like peptide 1 receptor agonists and other drugs to help weight loss, and in severe cases, even consider whether to perform metabolic weight loss surgery
.
All children with nonalcoholic fatty liver disease should have their blood pressure, lipids, and blood glucose
monitored annually.
Chronic disease management
should be included as the honorary leader of the fatty liver and alcoholic liver disease group of the Chinese Society of Hepatology, a member of the Asia-Pacific non-alcoholic fatty liver disease expert group, a member of the Global Expert Committee on Non-alcoholic Steatohepatitis, and an expert of the global working group on renaming non-alcoholic fatty liver disease, Professor Fan Jiangao and many other experts have been calling on the World Health Organization to treat non-alcoholic fatty liver disease as a chronic disease and asking member states to formulate corresponding health policies
.
To Fan Jiangao's regret, fatty liver was not included in the
"Healthy China 2030" planning outline.
He said: "The direction of our efforts now is to use the government's health policies and health regulations to launch a systematic comprehensive prevention and treatment strategy
for fatty liver.
" As hepatologists, we should also actively do health education for patients, and do follow-up education and standardized training
for non-specialist doctors.
"
One of the things Fan Jiangao is doing is to develop digital medical treatment for metabolic-related fatty liver disease, hoping to develop mobile phone application software, combine health data with people's health data, give real-time health information feedback, and help users adjust diet, promote exercise and rational drug use, so as to achieve the purpose of
preventing fatty liver and its comorbidities.
"
"Foreign countries have achieved better prevention and treatment results
through digital medical treatment for diseases such as type 2 diabetes, childhood ADHD, sleep disorders, and bronchial asthma.
The prevention and treatment of chronic diseases is a process that needs to be adhered to for a long time, which is most suitable for digital medical auxiliary management, through smart devices, doctors can also grasp patient health information and adjust treatment plans in a timely manner, and give patients real-time guidance
.
"
Because most fatty liver is found during physical examinations, Professor Fan Jiangao plans to release a health management service package
for fatty liver early next year.
" We have met and discussed the guiding principles several times, and I am drafting the content to be published in full in the Chinese Journal of Health Management in March next year, and the physical examination center will be obliged to conduct a face-to-face health education and guidance
for fatty liver detection patients in the future.
He pointed out that 85% of fatty liver patients may be simple fatty liver, the real increase in transaminases is about 15%, there is liver fibrosis 5% ~ 7%, so only 15% of fatty liver patients will enter the gastroenterology outpatient clinic, and the remaining 85% need to give health guidance and follow-up
in the general practitioner or health examination center.
If not intervened in time, more than 20% of patients with alcoholic fatty liver will develop alcoholic hepatitis, cirrhosis and even hepatocellular carcinoma within 10 years, although the disease of non-alcoholic simple fatty liver progresses slowly, only about 1% of people will develop cirrhosis within more than 10 years, but within 5~10 years, the risk of metabolic syndrome, type 2 diabetes, coronary heart disease will be significantly increased
compared with the general population.
It should be noted that from simple fatty liver to steatohepatitis, to liver fibrosis, cirrhosis, and even liver cancer and liver failure, although it is a progressive process, there are also 35%~40% of fatty liver-related liver cancer, skipping the cirrhosis stage and directly progressing to liver cancer
.
Fan Jiangao said that people with fatty liver should pay more attention to weight, waist circumference, metabolic and cardiovascular disease risk factors
.
Most patients have simple fatty liver disease, usually without medication, and most can return to normal
with effective lifestyle interventions.
In the past five years, Mr.
Tian has been diagnosed with mild fatty liver during five physical examinations, and for the sixth physical examination this year, he successfully lost 5 kg of weight, hoping to get a good physical examination result
.
But he also knows that even if the physical examination indicators can return to the normal range, if you do not insist on exercise and develop good living habits, it will soon be reflected in the
next physical examination.
Expert profiles
Dr.
Fan Jiangao, Director of the Department of Gastroenterology, Second-level Professor and PhD Supervisor, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Leading Talent, New Century Outstanding Talent
of the Ministry of Education 。 Chairman of the Hepatology Science Popularization Committee of the Chinese Medical Doctor Association, the Fatty Liver Expert Committee, the Chronic Disease Management Branch of the Chinese Pharmaceutical Biotechnology Association, the director of the China Hepatitis Prevention and Control Foundation, the executive director of the Cross-Strait Medical and Health Exchange Association, the honorary leader of the fatty liver and alcoholic hepatology group of the Chinese Society of Hepatology, the honorary chairman of the Shanghai Hepatology Society, the editor-in-chief of the Journal of Practical Hepatology, JCTH, CMH, CMJ, WJG, JDD and other SCI journals, Associate Editor
.
He has edited 19 monographs and popular science books, and ranked first
among the top 100 experts in the field of liver disease in China in terms of academic influence in 2021.
Source: Medical community
Editor-in-charge: Wen Jiaxin
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