{"id":1800,"date":"2019-09-16T18:26:13","date_gmt":"2019-09-16T18:26:13","guid":{"rendered":"https:\/\/www.danielleal.pt\/?p=1800"},"modified":"2019-09-20T11:52:45","modified_gmt":"2019-09-20T11:52:45","slug":"fatty-liver-a-silent-epidemic","status":"publish","type":"post","link":"https:\/\/danielleal.pt\/en\/fatty-liver-a-silent-epidemic\/","title":{"rendered":"Fatty Liver – A Silent Epidemic"},"content":{"rendered":"

Non-alcoholic liver disease is an increasingly common entity and is expected to be the leading cause of liver transplantation in the near future.<\/span><\/p>\n

The association between alcohol consumption and fat accumulation, under the form of triglycerides, in the liver is well established. However, this process is not exclusive to alcohol, and metabolic problems linked to insulin resistance can cause similar changes. <\/b>When the patient has a fatty liver in the absence of alcohol consumption, the condition is referred to as \u201cNon-Alcoholic Fatty Liver Disease\u201d (NAFLD).<\/span><\/p>\n

What is the prevalence of this disease?<\/span><\/strong><\/p>\n

At present, it is estimated that about 25% of the world’s population has NAFLD, <\/b>which corresponds to an accumulation of at least 5% of the total liver mass in triglycerides. The prevalence is higher in patients with obesity (50%) and in those with type 2 diabetes mellitus (70%), <\/b>which reflects the importance of insulin resistance in the development and progression of this condition.<\/span><\/p>\n

What causes NAFLD?<\/span><\/strong><\/p>\n

The liver is the most important organ from the metabolic standpoint. One of its functions is to store energy in the form of glycogen and to produce triglycerides, which can be used as an energy source or reserve in other tissues. In the presence of a high-calorie diet, particularly rich in refined carbohydrates, a hyperinsulinemic state ensues and leads to excessive fat production in the liver. <\/b>Fructose is a type of sugar present in fruit, but in higher proportions in refined sugar (about 50% of sugar is composed of fructose), and it is especially harmful to the metabolism. In parallel, if there is a deficiency of the nutrients involved in fat (triglycerides) export from the liver, in their specialized carriers – lipoproteins (VLDL) – the problem gets worse.<\/span><\/p>\n

What is the clinical course of the disease?<\/span><\/strong><\/p>\n

NAFLD is often asymptomatic, which precludes an early diagnosis,<\/b> most of the times. In its early stage, there is fat accumulation in the liver without inflammatory changes, and this is called simple steatosis. However, 20-30% of patients go on to develop inflammatory changes in the liver, with hepatocyte injury and fibrous tissue formation. <\/b>This advanced stage of the disease is called non-alcoholic steatohepatitis (NASH), and 7-25% of these cases may progress to liver cirrhosis.<\/span><\/p>\n

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Figure 1 – Schematic representation of NAFLD progression<\/span><\/h4>\n

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Figure 2 – Changes in the anatomical structure of the liver during the various stages of NAFLD.<\/span><\/h4>\n

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How is NAFLD diagnosed?<\/span><\/strong><\/p>\n

In the steatosis phase, without inflammatory changes, the liver function tests (ALT, AST, GGT, etc.) are normal in 80% of the cases, which renders them unuseful for the diagnosis.<\/b> Imaging studies are, therefore, essential in the diagnosis of NAFLD, and the options range from ultrasound to magnetic resonance imaging. Ultrasound is a more accessible exam and should be the initial choice.<\/b> When there is steatohepatitis, liver function tests tend to be altered. However, a definitive diagnosis is made only by liver biopsy.<\/b><\/span><\/p>\n

What is the treatment for this condition?<\/span><\/strong><\/p>\n

Being NAFLD a metabolic disorder, it is logical that the initial approach focuses on this area. When patients are overweight, which happens in the majority of cases, loss of, at least, 10% of body weight is recommended. <\/b>A low-calorie diet high in protein and fiber and low in sugars and saturated fats is a good option in these cases. Some nutrients are particularly important, such as the following:<\/span><\/p>\n