Fatty Liver Fatty liver disease, abbreviated as fatty liver, is a clinical syndrome characterized by diffuse fat accumulation in liver cells due to various reasons, which means that an excessive amount of fat accumulates within liver cells, affecting the normal function of the liver.

Fatty liver, also known as hepatic steatosis, is a clinical syndrome characterized by the pathological feature of diffuse fat accumulation within liver cells, which affects the normal function of the liver.

Fatty liver is a metabolic liver disease that primarily results from excessive fat accumulation and reduction in liver mass, microstructural disruption of liver tissue, and increased liver fragility, leading to a systemic metabolic liver disease in which patients are prone to fractures.

Fatty liver affects over a quarter of adults globally, with no significant difference in prevalence between Eastern and Western countries. The prevalence of fatty liver in China is as high as 27%, and the onset of the disease is trending towards younger ages, with an increasing number of cases in children. Major contributing factors include:

- A diet high in fat, fructose, and calories

- Sedentary lifestyle

- Increased alcohol consumption

- Genetic susceptibility

The prevalence of fatty liver in patients with obesity, metabolic syndrome, type 2 diabetes, and chronic excessive alcohol consumption is over 50%.

Alcoholic Liver Disease

Chronic liver damage caused by prolonged excessive alcohol consumption initially presents as alcoholic fatty liver, which can progress to alcoholic steatohepatitis (ASH), liver fibrosis, and cirrhosis.

Non-Alcoholic Fatty Liver Disease (NAFLD)

Chronic liver damage caused by genetic susceptibility and nutritional excess and its complications (insulin resistance, obesity, metabolic syndrome, type 2 diabetes) results in a spectrum of diseases including non-alcoholic fatty liver (NAFL), non-alcoholic steatohepatitis (NASH), and related cirrhosis.

Special Types of Fatty Liver

This mainly refers to fatty liver caused by certain drugs (tamoxifen, amiodarone, sodium valproate, methotrexate, corticosteroids, etc.) and environmental toxins (antimony, barium, organic solvents, etc.), as well as total parenteral nutrition, inflammatory bowel disease, malnutrition, and genetic conditions such as hepatitis C virus infection, hepatic glycogenosis, autoimmune hepatitis, familial hypobetalipoproteinemia, lipodystrophy, Mauriac syndrome, and progressive muscular dystrophy.

Acute Fatty Liver

This is a rare type of fatty liver disease with a very low overall incidence, mainly caused by pregnancy-related acute fatty liver, HELLP syndrome, Reye syndrome, and alcoholic foamy liver degeneration.

Rapid weight gain, overweight, obesity, especially visceral obesity with an excessive waist circumference

High blood pressure, dyslipidemia, hyperglycemia (diabetes), hyperuricemia (gout)

High-calorie diet rich in saturated and trans fats, cholesterol, sugary drinks, and heavily processed foods

Eating too quickly, overeating, preference for snacks, sweets, and meat, skipping breakfast, having a heavy dinner, and eating late-night snacks

Prolonged sitting, lack of physical activity, and muscle atrophy

Smoking, alcohol consumption, insufficient sleep, and chronic sleep deprivation

Hypothyroidism, hypopituitarism, polycystic ovary syndrome, and sleep apnea

Middle-aged and elderly individuals, malnourished and chronic liver disease patients

Individuals with a family history of obesity, diabetes, hyperlipidemia, coronary heart disease, and fatty liver, as well as certain genetically susceptible individuals.

The onset is insidious, the progression is slow, and generally there are no symptoms.

A few patients may experience fatigue, discomfort in the upper right abdomen, sleep disturbances, and constipation.

Some patients may have hepatomegaly, and a few patients may also have splenomegaly.

During the decompensated stage of cirrhosis, the symptoms are similar to those caused by other etiologies.

For patients with acute fatty liver of pregnancy, HELLP syndrome, Reye's syndrome, as well as severe or even fulminant alcoholic fatty liver disease, treatment should follow the methods used for severe hepatitis and liver failure, providing intensive care and aggressive treatment. In addition, timely termination of pregnancy can have a good effect in removing the cause for patients with acute fatty liver of pregnancy and HELLP syndrome.

For patients with Fatty Liver who are overweight, obese, have recently gained weight, or have "hidden obesity," dietary control, increased physical activity, and correction of unhealthy behaviors are necessary to reduce body fat content and prevent sarcopenia. Regardless of obesity, patients with non-alcoholic fatty liver disease (NAFLD) can improve liver fat with a 3% to 5% reduction in body weight within a year, and a 7% to 10% reduction can normalize serum transaminases, and improve non-alcoholic steatohepatitis (NASH) and liver fibrosis.

Healthy diet

For patients with non-alcoholic fatty liver disease (NAFLD) and alcoholic liver disease who are overweight or obese:

Moderate control of dietary caloric intake, with a recommended daily reduction of 2092 to 4184 kJ (500 to 1000 kcal);

Adjustment of dietary structure, with a balanced diet of moderate fat and carbohydrates, restriction of sugary drinks, pastries, and heavily processed refined foods, and increased intake of whole grains, omega-3 fatty acids, dietary fiber, and water;

Regular, moderate meals three times a day, strict control of dinner calories and post-dinner eating behavior.

Regular exercise

Avoid prolonged sitting and inactivity, maintain moderate aerobic exercise such as brisk walking, for 30 to 60 minutes each time, five times a week; or 20 minutes of high-intensity aerobic exercise every day, three times a week, combined with 8-10 sets of resistance training twice a week.

Avoid exacerbating liver damage

Avoid very low-calorie diets for weight loss, avoid the use of potentially hepatotoxic Chinese and Western medicines, use caution with health supplements, limit alcohol consumption and avoid excessive drinking, and effectively treat concurrent diseases, such as sleep apnea syndrome, polycystic ovary syndrome, hypothyroidism, and small intestinal bacterial overgrowth, which may exacerbate liver damage.

Liver Transplantation

Patients with alcoholic cirrhosis should actively prevent and treat complications. Liver transplantation can be considered for end-stage liver disease after 3-6 months of abstinence.

For patients with severe alcoholic hepatitis and slow-onset acute liver failure, liver transplantation should be promptly considered if abstinence and conservative treatment are ineffective.

Patients with non-alcoholic steatohepatitis (NASH)-related end-stage liver disease and hepatocellular carcinoma can consider liver transplantation. The overall survival rate after liver transplantation is similar to that of liver transplantation for other causes.

Effective control of weight and prevention of metabolic disorders are still necessary after liver transplantation to minimize the occurrence of post-transplant complications.

Bariatric Surgery

Also known as metabolic surgery, it not only maximizes weight loss and long-term maintenance of ideal weight, but also effectively controls metabolic disorders, and may even reverse type 2 diabetes, metabolic syndrome, and related steatohepatitis and liver fibrosis.

Patients with type 2 diabetes and severe obesity (BMI ≥ 37.5 kg/m2), as well as those with moderate obesity (32.5 kg/m2 ≤ BMI ≤ 37.4 kg/m2) but ineffective conservative treatment for controlling blood sugar, can consider bariatric surgery.

Patients with mild obesity (BMI 27.5-32.4 kg/m2) who cannot effectively control metabolism and cardiovascular risk factors with conservative treatment can also consider bariatric surgery.

Bariatric surgery can not only alleviate histological changes in liver tissue, including fibrosis, in patients with NASH, but may also reduce cardiovascular disease mortality and all-cause mortality. However, its role in improving liver-related complications has not been confirmed.

There is currently insufficient evidence to recommend bariatric surgery for the treatment of NASH. It is not a contraindication for obese patients with NASH or compensated cirrhosis to undergo bariatric surgery.

The etiology and treatment of fatty liver are complex. Non-alcoholic steatohepatitis involves various syndromes in traditional Chinese medicine such as "phlegm syndrome," "dampness obstruction," "distension and fullness," "accumulation syndrome," and "flank pain," while alcoholic liver disease involves TCM syndromes such as "alcohol jaundice," "flank pain," "injury from alcohol," "alcohol addiction," "alcohol distention," and "alcohol drumming."

For various types of fatty liver with known causes and mechanisms, it is recommended to base treatment on syndrome differentiation, aiming to analyze the similarities and differences in symptoms presented by different patients and their causes, and then develop corresponding treatment methods and prescriptions.

Healthy Diet

Develop a reasonable dietary plan based on the patient's nutritional status. Patients with calorie and protein deficiency should be given a high-calorie, protein-rich, vitamin- and mineral-rich diet, eating small meals frequently and adding a meal before bedtime.

Patients with overweight and abdominal obesity should reduce calorie intake, follow a low-sugar, low-fat diet, eat three regular meals, avoid sugary drinks, processed foods, late-night snacks, and develop an individualized dietary plan based on blood pressure, blood sugar, blood lipids, and uric acid levels.

Increase Physical Activity

Fatty liver patients should develop the habit of exercise, striving to "stand instead of sit, walk instead of stand, walk fast instead of walk slow, and have a longer rather than shorter activity time." Walking briskly or cycling to and from work is the best form of exercise, but safety should be considered and excessive fatigue avoided. Quit smoking and limit alcohol consumption, drink less strong tea and coffee, maintain a regular lifestyle, and avoid staying up late.

The occurrence and development of fatty liver are mainly related to factors such as obesity, type 2 diabetes, and alcohol abuse, so comprehensive preventive measures must be taken to achieve good results.

Adjust Dietary Structure

Adhere to the traditional Chinese dietary plan of "plant-based foods as the main source, animal-based foods as a supplement, and grain-based energy sources" and avoid the dietary structure defects of Western societies, which are characterized by "high energy, high fat, high protein, low fiber, and processed foods."

Correct Unhealthy Eating Habits

Eat regular and moderate meals, eat a full breakfast, a good lunch, and a moderately full dinner, avoid overeating, eating fast, snacking, eating sweets, eating late-night snacks, and drinking sugary drinks.

Limit Alcohol Consumption

For those who frequently drink excessively, reducing alcohol consumption or completely abstaining is the only effective way to prevent the occurrence and development of alcoholic liver disease; other preventive measures are "seeking fish in a tree."

People who are not tolerant to alcohol or experience symptoms such as nausea, vomiting, rapid heartbeat, and flushing after consuming small amounts of alcohol, or those with a family history of alcoholic liver disease, should completely abstain from alcohol.

Increase Physical Exercise

According to individual circumstances, adhere to more than 150 minutes of moderate aerobic exercise per week and persist in doing so. At the same time, avoid the unhealthy habit of "sitting for long periods and moving less."

Use Various Chinese and Western Medicines with Caution

The liver is the main site of drug metabolism, and improper use of medications can easily cause fatty liver and liver damage.

Regular Health Check-ups

Those with obesity, diabetes, hyperlipidemia, and a family history of fatty liver should be aware of self-care, undergo regular screenings, and timely treat fatty liver, diabetes, and other chronic diseases.