“Non-alcoholic fatty liver management, ‘weight loss’ is the top priority” [인터뷰]

A normal liver contains about 5% fat. Fatty liver refers to a condition in which the amount of fat deposited in the liver exceeds 5%. Fatty liver is mostly asymptomatic, and it is common in 20-30% of adults, so there are not a few cases that are neglected without proper treatment. However, neglected fatty liver can cause various complications and symptoms, so care must be taken. We discussed the importance of fatty liver treatment and treatment methods with Seo Ji-ho, director of internal medicine (Jangsoksok Internal Medicine).

Seo Ji-ho, director of Jangsoksok Internal Medicine|Source: Haidak

Q. What is the difference between alcoholic and non-alcoholic fatty liver?
It is classified into alcoholic and non-alcoholic according to the amount of alcohol consumed. Non-alcoholic fatty liver disease is classified as non-alcoholic fatty liver disease if you do not drink alcohol or drink only a small amount. A small amount here is based on alcohol intake of no more than one bottle of soju per week for women and no more than two bottles of soju per week for men.

The prevalence of fatty liver is rapidly increasing due to the recent increase in the population of obesity and diabetes, and it is estimated to occur in about 20-30% of adults in Korea. Non-alcoholic fatty liver disease can progress not only to simple fatty liver but also to end-stage liver diseases such as cirrhosis (cirrhosis of the liver) and hepatocellular carcinoma. In particular, since the risk of cardiovascular disease is high, active management is required.

Q. What are the diagnosis methods and criteria?
Liver function tests and abdominal ultrasonography are often used. However, liver function tests are often normal, so abdominal ultrasound is recommended as the primary screening test. If non-alcoholic fatty liver disease is suspected through abdominal ultrasonography, non-invasive tests such as CT, MRI, serum test, and liver fibrosis scan can be performed as additional tests. Invasive liver biopsy can also be considered in high-risk groups with advanced liver fibrosis or in cases where exclusion of other liver diseases is required.

In particular, a screening test for non-alcoholic fatty liver disease is required if there is a persistent elevation of liver level in a health checkup. In case of diabetes, active examination is recommended regardless of liver level.

Q. Are there any symptoms of non-alcoholic fatty liver disease?
There are no specific symptoms. However, depending on the course of the disease, various symptoms may accompany it. Mild fatty liver with only simple fat and no liver cell damage has no symptoms, but if liver cell damage is severe and lasts until cirrhosis (liver cirrhosis), severe fatigue, itching, ascites or jaundice may accompany it.

The reason why the liver is often called the silent organ is because there are no abnormalities in blood tests or subjective symptoms even when liver cirrhosis progresses to moderate or severe degree. Therefore, if you have risk factors, it is recommended to have blood tests and abdominal ultrasound follow-up tests periodically.

Fatty Liver|Source: Getty Image BankFatty Liver|Source: Getty Image Bank

Q. Is non-alcoholic fatty liver a disease that requires management and treatment?
Non-alcoholic fatty liver is associated with cirrhosis of the liver (cirrhosis) and hepatocellular carcinoma due to continuous liver cell damage, as well as metabolic syndrome such as obesity, diabetes, and insulin resistance, which leads to increased mortality due to cardiovascular diseases and liver-related complications. Therefore, it needs to be managed and tracked.

The most important thing in the treatment of fatty liver is lifestyle modification. Weight loss of 5% or more is required, a diet that includes a total energy intake reduction of 500 kcal or more per day, moderate-intensity exercise therapy for at least 30 minutes at least 3 times a week, and alcohol restriction are required.

Reducing overall calorie intake is particularly important. A low-fat diet is important, but a low-carb diet is even more important. It is recommended to reduce the intake of carbohydrates and eat a good balance of fat and protein. It is recommended to do aerobic exercise such as walking, jogging, swimming, and biking at moderate intensity for 30 to 60 minutes at least twice a week for at least 6 weeks.

Q. Are there any nutritional supplements that help improve fatty liver?
To date, no nutritional supplements have been proven to have therapeutic effects. Nutrients that are helpful or help with metabolic syndrome associated with non-alcoholic fatty liver are recommended on the Internet, but the management of fatty liver through weight loss described above is the most effective and important.

In addition, non-alcoholic fatty liver increases the incidence and mortality of cardiovascular disease, so patients with cardiovascular risk factors require treatment for the disease. Lastly, taking health juices and nutritional supplements, not prescription medicines prescribed by a specialist, may cause liver level elevation or hepatocyte synthesis dysfunction, so it is recommended that you consult with your doctor before taking them.

Help = Director Seo Ji-ho (Jangsoksok Internal Medicine Specialist)

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