Text: ◇Chen Qiulei/He Jianxing Compiled by: Liang Yingxiu
(Kuala Lumpur News) What is fatty liver? First of all, we must clarify how to define fatty liver. Normally, the fat content of the liver is 5%. Once it exceeds the standard, it can be defined as fatty liver.
Research shows that people over 60 years old, those with high education, overweight and obesity, and those with metabolic diseases are all classified as high-risk groups for fatty liver disease. If it is not treated in time or appropriate changes are made, complications such as cirrhosis and liver cancer will occur.
The general public has little knowledge about fatty liver disease, has very little awareness of liver protection, and even seems ignorant of the complications it brings.
22% to 37% of people have fatty liver
Dr. Ngiu Chai Soon, Consultant of Hepatogastroenterology, pointed out that in Malaysia, half of the population is classified as overweight or obese, and 22% to 37% of them suffer from fatty liver disease, which means that one in three people has fatty liver disease. One person is facing the problem of fatty liver.
As for how to define overweight and obesity, internationally the body mass index (BMI, referred to as body mass index) is used to measure whether a person is fat or thin beyond the standard. In Asia, a BMI greater than 23.5kg/㎡ is considered overweight, and a BMI greater than 30kg/㎡ is considered obese.
In addition to using BMI as an indicator, the waist circumference index (Waist Circumference, WC) can also be used to determine whether a person is at risk of fatty liver disease. However, the most commonly used identification method is still based on BMI.
“Is what we call fatty liver just as simple as fatty liver? In fact, it is not. Fatty liver disease can be roughly divided into alcohol-associated liver disease (ALD) and non-alcoholic fatty liver disease. Liver Disease (NAFLD) and more severe non-alcoholic steatohepatitis. After blood testing, most patients with fatty liver disease have non-alcoholic fatty liver disease (non-inflammatory), accounting for 80%, and the other 20% have worsened to non-alcoholic fatty liver disease. Alcoholic steatohepatitis.”
He said that non-alcoholic fatty liver disease, as the name suggests, has nothing to do with alcohol. Therefore, when testing patients, doctors must also confirm their alcohol consumption. His alcohol intake did not exceed 14 units per week, and other chronic liver diseases were excluded, and he was diagnosed with non-alcoholic fatty liver disease.
Chinese account for 25% and Indians 50%
Another condition, non-alcoholic steatohepatitis, is an inflammation of liver cells. Without appropriate treatment, it may lead to subsequent adverse consequences, such as cirrhosis and liver failure.
In addition, studies have shown that fatty liver can also cause complications from non-liver diseases, such as heart disease, stroke, atherosclerosis, etc. Studies have also pointed out that patients with fatty liver have an increased risk of cancer.
“Fatty liver has no obvious symptoms, and when it is discovered, the condition is often quite serious.” Data shows that among the ethnic groups suffering from fatty liver in Malaysia, Chinese account for 20% to 25%, Indians account for 50%, and Malays account for 40%. % to 60%. Our country is an Islamic country, and Muslims are prohibited from drinking alcohol. However, judging from the above racial ratio, the proportion of Malays is quite high.
He pointed out that the formation of non-alcoholic fatty liver disease has nothing to do with alcohol, but is inseparable from our daily life. Poor daily routine and eating habits are the “culprits” of suffering from this disease.
In addition to lifestyle habits, other factors will also increase the chance of fatty liver, such as obesity, high blood pressure, dyslipidemia, and diabetes. Women may also suffer from acute fatty liver during pregnancy. This disease may lead to acute failure and sometimes even It can be life-threatening and is usually handled by a gynecologist.
“Of course we should also consider other causes of hepatic steatosis, including drugs, viral hepatitis, Wilson’s Disease, malnutrition, etc.”
Untreated can lead to cirrhosis of the liver
“There is no time limit for the process from non-alcoholic fatty liver disease to non-alcoholic steatohepatitis. Even people under the age of 40 may have already suffered from non-alcoholic steatohepatitis.”
He reminded the public, “Once you have non-alcoholic steatohepatitis, if you do not take care of it and receive treatment, it is very likely to lead to liver cirrhosis. The degree of liver cirrhosis can be divided into 5 levels (0-4); 0-1 is No or mild fibrosis; 2-3 indicates severe fibrosis; 4 indicates signs of cirrhosis.”
The numbers above remind us time and again that fatty liver poses a serious threat to health. It has no obvious symptoms, so regular examination is the only way to protect the liver.
According to the 2022 Treatment Consensus issued by the Malaysian Liver Association, it is recommended that anyone over 30 years old should undergo routine physical examinations, such as blood and ultrasound tests. This test can mainly diagnose metabolic syndrome hepatitis.
During a normal routine check-up, doctors will first measure weight, height, blood pressure and other tests; and when performing an abdominal examination on the patient, they can detect swelling of the liver.
To detect fatty liver, the most common method on the market is ultrasound screening. Generally, large clinics are equipped with ultrasound equipment, which is convenient and affordable. In addition to ultrasound, people can also do fatty liver detection through liver fibrosis scan (fibro scan) or magnetic resonance imaging (MRI).
Regular physical examination for those over 30 years old
The consequences of fatty liver cannot be underestimated, and there are various detection methods. He suggested that people over 30 years old should have regular physical examinations to nip problems in the bud.
If a person already has fatty liver and even reaches the inflammatory stage but still refuses to intervene in treatment, what harm will happen next? First, liver fibrosis will occur, and there is a high chance of deteriorating into cirrhosis, which will eventually lead to a greater chance of complications such as liver cancer.
“In addition to liver cancer, when liver cirrhosis becomes more and more severe, it will cause venous aneurysms to enlarge and rupture, and even cause bleeding in the esophagus and stomach. In addition to dizziness and coma, patients will suffer from hepatic encephalopathy (HE).”
“Ascites can also occur in cirrhosis or other serious liver diseases, as well as jaundice/icterus and spontaneous bacterial peritonitis, etc., which all have a risk of death and must be taken very seriously.”
Of course, in many cases, patients do not seek medical treatment until they are in such a serious condition. They may just be feeling tired due to certain reasons, such as being unsure of their condition, or mistakenly thinking that they are tired due to heavy work recently, but they did not expect that it is “fatty liver”. cause trouble.
Adjust your daily routine
Liver cirrhosis has a chance of reversal
When a person has fatty liver or even early stage liver fibrosis, is there any chance of “reversal”?
In fact, as long as liver cirrhosis has not yet occurred, immediate intervention and intervention, including adjustments to daily routine, can definitely change the outcome.
Wei Caishun pointed out that the prerequisite is that you must persevere and incorporate good living habits, such as a balanced diet, moderate exercise and weight loss, into your daily routine, so that you can seize the final “reversal” opportunity.
Oral drugs improve fatty liver disease
So how long does the so-called perseverance mean? There is no relevant research so far, because in order to diagnose how long it will take for a person’s liver to see improvement after adjusting their daily routine, liver samples must be taken for testing.
However, from a clinical point of view, if a person does not improve his or her daily routine, the liver may deteriorate and be on the verge of cirrhosis in 5 to 15 years, depending on the patient’s physical constitution and health status.
“It must be emphasized that as long as a person makes up his mind to change before the onset of cirrhosis and persists, he will definitely see different results.”
He said that thanks to the prosperity and development of medicine, many scientific studies have found that oral drugs have a certain effect in improving fatty liver and hepatitis, among which S-adenosylmethionine or S-adenosylmethionine (Sadenosyl- L-Methionine (SAMe) has been clinically proven to improve the damage caused by liver damage after multiple scientific studies.
“What impressed me most about it is its antioxidant function, and antioxidant is the key to improving liver damage.” Simply put, SAMe is a very important methyl donor present in the human body, and many contain Nitrogen biosynthesis requires methyl groups from SAMe, such as epinephrine, creatine, etc.
“Actually, SAMe is originally secreted by the liver, but once a person’s liver is damaged, its secretion will be affected and reduced. Additional supplements, such as oral medications, are needed to obtain the amount the body needs.”
Take SAMe to avoid inflammation
According to general guidelines, as long as you consume enough SAMe, you can not only reduce the chance of liver inflammation, but also avoid the occurrence of inflammatory hepatitis. As for men and women with fatty liver, a common symptom is fatigue, and another effect of SAMe is to improve fatigue symptoms.
It is worth noting that SAMe has sufficient data in scientific research and is an over-the-counter (OTC) drug. It is best used before liver cirrhosis occurs. “However, it is recommended that you still consult a doctor or pharmacist for professional advice before taking it, including the dosage per time or how many times a day it should be taken.”
He would like to emphasize that SAMe is not a “liver-protective drug” as claimed, especially for men and women who drink alcohol. If a person has liver damage caused by long-term alcohol abuse, but is unwilling to quit drinking and only wants to rely on SAMe to improve liver function, this is a problem. Unrealistic approach.
So can SAMe be taken in from daily diet? The answer is no. “But if you are a patient with liver disease, I would suggest that he pay attention to the following three points in his daily diet. First, he must reduce or eliminate processed foods as much as possible, preferably whole foods, such as whole chicken. , fish or vegetables, etc. As for canned foods, instant noodles or sausages, they are all considered processed foods.
The second point is definitely “good news” for coffee lovers, that is, drink more sugar-free and milk-free black coffee. So far, research shows that black coffee (regardless of origin) can help reduce liver fibrosis. risk, but its mechanism of action remains to be clarified.
The last point is the intake of vitamin E. However, it should be noted that excessive intake of vitamin E also has side effects, so it is recommended to intake vitamin E in moderation and follow the instructions given by your doctor.
Exercise at least 3 times a week
For patients with fatty liver or liver disease, his advice is to develop a good lifestyle, that is, follow the recommendations given by the World Health Organization, such as maintaining exercise at least three times a week, for no less than 30 minutes each time. At the same time, the diet should be balanced.
Then, according to the doctor’s instructions, you must have a physical examination after reaching a certain age. “Prevention is better than cure” and “treating the disease with simple Chinese medicine” are always important medical truths.
Nowadays, more and more diseases are affecting younger people. In fact, it is necessary for men and women over 30 years old to start the habit of physical examination, so that they can early detect the health damage lurking in the body, such as fatty liver, etc., and at the same time understand health After understanding the situation, we can start to improve it fundamentally by taking appropriate measures, so that we can usher in a healthy life.
If you have hepatitis B, you should continue to take medicine
Question 1: My husband has hepatitis B and has been taking medicine since 2009. His annual blood test shows no B antibodies and everything else is normal. Although doctors recommend taking medicine as usual every day, when can you stop taking it?
Answer 1: If a person has hepatitis B or hepatitis C, he or she needs to start taking medication. Although the annual blood test results showed no B antibodies, the liver function tests were all normal. In this case, it means that the drugs he took have successfully controlled the disease, so the test showed no abnormalities.
However, once the medication is stopped, the viral load will gradually increase, which may eventually lead to explosive hepatitis, so I recommend continuing to take the medication.
Thyroid problems affect metabolism
Question 2: Will liver problems affect body metabolism? Can thyroid symptoms lead to liver problems?
Answer 2: The liver is a very important organ. It is very important for the metabolism of blood sugar and blood lipids in our body. In other words, when there is a problem with our body, such as the liver, it will affect metabolism.
As for the thyroid gland, there are two conditions: hyperthyroidism and hypothyroidism. Both conditions can lead to liver inflammation, but the inflammation mechanisms are different.
Blushing after drinking alcohol has nothing to do with liver function
Question 3: If your face turns red immediately after drinking alcohol, is it because your liver function is not good?
Answer 3: Your face turning red immediately after drinking alcohol may not necessarily be due to poor liver function. It is actually related to the metabolic enzymes in your body. Some people are born with higher activity of alcohol dehydrogenase, so they metabolize faster, are less likely to blush, and have a relatively good alcohol capacity, but this is different from liver function.
There are many causes of facial pigmentation
Question 4: Pigmentation on the face, is the liver damaged?
Answer 4: There are several reasons for pigmentation on the face. One of them is caused by liver damage. Other reasons include kidney damage, hormonal imbalance and some specific drugs.
Hepatitis C is more than 95% curable
Question 5: My ALT inflammation index is 466. After 10 years, the viral load was tested to be 2,186,270 IU/ml. Do I still have a chance to recover?
Answer 5: Although this patient mentioned a viral load test, he did not explain which type of hepatitis he had.
Basically, we will test the viral load of hepatitis B and C patients. The treatment plan for hepatitis B is to take medicine and do regular blood tracking tests, but the possibility of complete recovery is less than 1%. , the disease can only be controlled long-term with drugs.
As for the treatment of hepatitis C, it used to be injected, but now it can also be treated with medication. More than 95% of hepatitis C can be cured. Although the index of 466 is high, I think there is still a chance of cure.
Hepatitis B carriers are prohibited from donating blood or organs
Question 6: I am a hepatitis B carrier but I don’t take medicine. Can I donate blood or organs?
Answer 6: In Malaysia, hepatitis B carriers are not allowed to donate blood or organs. That’s because the hepatitis B virus can be hidden in donated organs, so it’s possible to pass the virus on to other people.
However, in recent years, foreign literature studies have pointed out that it is feasible for a hepatitis B patient to donate organs to a fellow hepatitis B patient.
People with liver cirrhosis should not eat more than 2 grams of salt
Question 7: If a family member has liver disease, can they add salt when cooking? How can I gain weight if I am very thin due to liver disease? Can I eat meat and oily food?
Answer 7: The salt intake of patients with liver disease depends on the degree of liver damage. If they are patients with complications of liver cirrhosis, it is generally recommended that they not consume more than 2 grams of salt.
Liver disease patients should not eat too much protein food. The main reason for losing weight is lack of protein.
In recent years, studies have pointed out that people with more severe liver cirrhosis require more protein than the average person, otherwise they will become even more emaciated and malnourished.
In addition, the possibility of liver cancer should also be considered, because cirrhosis will increase the risk of liver cancer.
Recommend vaccination for PSC patients
Question 8: I am 59 years old and a patient with Primary Sclerosing Cholangitis (PSC). How should I protect my liver?
Answer 8: PSC is a congenital liver immune disorder and is also a type of chronic hepatitis. How to take care of it depends on whether there are antibodies against hepatitis A or B first. If not, vaccination is generally recommended.
Patients with this type of disease must also pay attention to diet and living habits, such as correct and adequate nutritional intake, moderate exercise, etc. PSC is a difficult disease to treat, so it needs to be tested regularly.
However, depending on the degree of liver damage, you may need to go to the hospital for follow-up visits every three months or six months.
Answer◇Dr. Wei Caishun, Consultant of Hepatogastroenterology