Non-alcoholic fatty liver disease

Posted by Doctor Nguyen Viet Anh - Head of Department and Specialist Doctor 1 Vo Cong Hien - Diagnostic Imaging Department - Vinmec Nha Trang International General Hospital

Currently, non-alcoholic fatty liver disease (NAFLD) is the most common cause of elevated liver enzymes. The best way to prevent and treat the disease is to know the progression and early symptoms of the disease.

Nonalcoholic fatty liver disease (NAFLD) manifests itself in the following signs:
Patient has fatty liver on histology or on imaging (abdominal ultrasound, CT scan, MRI...). Often accompanied by factors such as obesity, type 2 diabetes, dyslipidemia. There is no other cause of secondary fatty liver such as alcohol consumption, hepatitis C infection, Wilson's disease, lipodystrophy, malnutrition, prolonged parenteral nutrition, drug use (amiodarone, methotrexate). , tamoxifen, corticosteroids, valproate, anti-retroviral.... ), acute fatty liver in pregnant women, congenital metabolic defects.

Subjects susceptible to NAFLD usually include people with obesity, type 2 diabetes, dyslipidemia, metabolic syndrome, polycystic ovary syndrome, hypothyroidism, sleep apnea syndrome, hypopituitarism, hypogonadism, pancreaticoduodenectomy.
People with dyslipidemia: a high percentage of fat molecules (triglycerides) in the blood, low HDL cholesterol are also prone to non-alcoholic fatty liver disease. The rate of NAFLD in the group of patients with dyslipidemia accounts for about 59%
The rate of non-alcoholic fatty liver disease and the degree of liver disease increases with age, the risk of NAFLD in men is 2 times higher than in women, the disease also increases with age. different between ethnicities. This is explained by the difference in genetic factors.

Over the past two decades, there have been many studies on the natural course of nonalcoholic fatty liver disease. For patients who have progressed through non-alcoholic steatohepatitis (NASH), especially cirrhosis, there is an increased risk of cirrhosis (cirrhosis), mortality from liver disease .
Currently, nonalcoholic fatty liver disease is the most common cause of elevated liver enzymes. The prevalence of NAFLD in Europe is about 35%, in Asia it is about 25%.
Approximately 15 - 30% of the population has NAFLD, up to 12 - 40% of these patients will progress to non-alcoholic steatohepatitis (NASH), and about 15 - 25% of NASH patients will develop to cirrhosis, about 7% of cirrhotic patients will progress to liver cancer.

All individuals with persistent elevation of liver enzymes should be screened for nonalcoholic fatty liver disease, as this is a common cause of unexplained elevations in liver enzymes. Individuals who are obese: Monitoring for nonalcoholic fatty liver disease is imperative, because obesity is a risk factor for NAFLD and also increases the risk of disease progression. In individuals with type 2 diabetes, screening for non-alcoholic fatty liver disease is mandatory, regardless of liver enzyme levels, because of the high risk of disease progression in diabetic subjects. Individuals with dyslipidemia, metabolic syndrome.

5.1. To evaluate fatty liver Fatty liver should be identified by abdominal ultrasound, because ultrasonography is widely available and abdominal ultrasound also reveals additional hepatobiliary information. Therefore, abdominal ultrasonography is the first imaging modality to be performed in patients with nonalcoholic fatty liver disease. Another imaging technique is the controlled attenuation parameter (CAP) to diagnose fatty liver: This technique can determine the degree of fatty liver. The best fatty liver markers include: FLI ((Fatty liver index), SteatoTest and NAFLD liver fat score 5.2. To assess nonalcoholic steatohepatitis Patients with nonalcoholic steatohepatitis There is an increased risk of progression of liver fibrosis, cirrhosis and possibly liver cancer.These patients need close monitoring and more aggressive treatment.Clinical signs, biochemical tests, imaging imaging cannot distinguish non-alcoholic steatohepatitis from steatohepatitis alone. Liver fibrosis is an important prognostic factor in patients with nonalcoholic fatty liver disease.Hepatic fibrosis is correlated with liver disease outcome and mortality.It is necessary to closely monitor liver fibrosis progression. Liver fibrosis scores include: NFS ((NAFLD fibrosis score, FIB-4 (Fibrosis 4)), ELF (Enhanced Liver Fibrosis) and FibroTest. NFS can distinguish between severe and non-severe cirrhosis. He has severe cirrhosis of the liver. To assess for liver fibrosis, the gold standard is to use liver biopsy technique, but this is invasive technique. Evaluation of liver fibrosis by ultrasound liver elastography technique, which is a non-invasive technique, is used to identify low-risk cases of severe liver fibrosis and cirrhosis. The combination of biomarkers, liver fibrosis assessment index, and liver elastography can increase diagnostic accuracy, and avoid liver biopsy. Monitoring the progression of liver fibrosis in clinical practice can rely on a combination of biomarkers, liver fibrosis assessment indexes and liver elastography.

If the patient has only fatty liver, no non-alcoholic steatohepatitis, no cirrhosis, then a healthy diet and physical activity are required, and no drug treatment is required. For patients with non-alcoholic fatty liver disease, overweight, and obesity, a 7-10% weight loss is the goal of treatment, reducing liver enzymes and improving liver histology. Dietary recommendations: energy restriction should be considered and the elimination of food ingredients that promote NAFLD (Processed foods, fast foods, high content foods and beverages) should be considered. high fructose). Increase the amount of vegetables and fruits (every day should eat at least 300g of green vegetables, 200g of fresh ripe fruit). Prioritize choosing vegetable oil (except coconut oil), limit animal fat (except fish fat). Some foods are considered "medicines" that have a good "fat loss" effect such as: soybean oil, peas, fresh ripe tomatoes, yellow peppers, spinach, celery, lettuce, garlic, bananas (banana flower)...; fruit should pay attention to lemons, oranges, tangerines, grapefruit, ripe apples... green tea, flowers... Limit eating foods rich in cholesterol such as animal fat, heart foods, viscera, skin... Animals, egg yolks, cattle livers... Choose any exercise depending on the patient's preferences and can be maintained for a long time. Periodic examination of the liver specialist for monitoring, counseling and appropriate treatment in a timely manner. Drug therapy for patients with nonalcoholic steatohepatitis, especially for patients with significant cirrhosis (>F2). For patients without the above conditions, but at high risk of progression (Diabetes, metabolic syndrome, persistent elevations of liver enzymes, high necrotizingitis), drug therapy can be used to prevent progressive disease. >>See more: Advances in the treatment of non-alcoholic steatohepatitis - Article written by Master, Doctor Mai Vien Phuong - Gastrointestinal endoscopist - Department of Examination & Internal Medicine - General Hospital Vinmec Central Park International Faculty. Doctor has nearly 10 years of experience in the field of Gastrointestinal Endoscopy.

To evaluate liver fibrosis, go to Vinmec Nha Trang Hospital. With the advantages of ultrasound-elastic technique of liver tissue at Vinmec Nha Trang include:
LOGIQE S8 ultrasound system with powerful and flexible images to meet a wide range of general examination needs. With advanced, intuitive capabilities, the LOGIQ S8 allows you to use professional tools to get great images and accurate, highly reliable results. New technology using Shear Wave: Measuring the elasticity of the liver parenchyma by Quantitative method for increasing diagnostic value Through color coding table and values ​​of elasticity levels in pressure units kPa. The Shear Wave parenchymal elastography tool allows the user to actively localize the survey right on the ultrasound image. Images acquired during the survey can be easily marked and tracked. It is a non-invasive technique, has no contraindications and can be repeated many times. To register for examination and treatment at Vinmec Nha Trang International General Hospital, you can contact hotline: 0258 3900 168 or register online HERE.