Non-alcoholic fatty liver has appeared, and the key to blocking its transformation into cancer is...

It is only for medical professionals to read and refer to patients with non-alcoholic fatty liver.
One out of every four people is a non-alcoholic fatty liver (NAFLD) patient.
NAFLD refers to the degeneration of more than 5% of liver cell fat under the action of metabolic risk factors (especially obesity and type 2 diabetes).
And this steatosis is not caused by excessive drinking (male: ≥30 g/d; female: ≥20 g/d) or other chronic liver diseases
.

In the past four decades, NAFLD has become the most common chronic liver disease worldwide.
Overall, the global adult prevalence of NAFLD is approximately 25%, that is, one out of every four people is a NAFLD patient
.

Moreover, because NAFLD has an insidious onset, it is common for patients to be undiagnosed for decades.
Some patients do not even come to see a doctor until signs of liver cirrhosis and portal hypertension (hepatosplenomegaly) appear.
The actual number of patients is even higher.

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NAFLD is related to metabolism, but it does not mean that lean people can survive more than local lesions in the liver.
NAFLD is a manifestation of metabolic syndrome in the liver, which is related to obesity, insulin resistance, type 2 diabetes, hypertension, and hyperlipidemia.
Focus on reflection
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Up to 80% of obese people and 47.
3%-63.
7% of patients with type 2 diabetes have NAFLD
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But this does not mean that people with normal weight (BMI: Caucasian <25 kg/m2; Asians <23 kg/m2) are unlikely to develop NAFLD (under normal circumstances, obese people are more likely to have metabolic syndrome)
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NAFLD patients with normal weight are a group that cannot be ignored.
The academic community has also established a proper term for this, called non-obese NAFLD, or thin NAFLD.
.
.
Is it a heartbreak? Of course, not all lean people are prone to develop NAFLD.
These lean NAFLD patients usually have central obesity or other metabolic risk factors
.

A Hong Kong study showed [1] that among non-obese people, NAFLD patients have more insulin resistance than non-NAFLD patients (average homeostasis model assessment of insulin resistance: 2.
0±1.
0 vs 1.
1±1.
1; P< 0.
001), even if the blood sugar of the NAFLD patient is normal
.

On the way from NAFLD to liver cancer, these patients have a worse prognosis! Not only is the prevalence high, but NAFLD is the second leading cause of end-stage liver disease, as well as an important cause of primary liver cancer and liver transplantation
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Among the deaths caused by liver-related diseases, NAFLD causes the fastest increase in mortality, which brings a double burden of health and economy to people
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Is there a sudden rise in blood pressure and a little panic after reading this? In fact, patients don’t have to panic too much, here, this tells you good news, most NAFLDs will remain stable or progress slowly and will not cause cirrhosis
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Patients with high-risk complications of advanced fibrosis, end-stage liver disease and hepatocellular carcinoma mainly have the following characteristics.
Does Kangkang have it? Combined with other liver diseases In people with other liver diseases (such as alcohol-related liver disease, viruses, or autoimmune hepatitis), NAFLD often coexists.
Under the synergistic effect of the original liver disease and NAFLD, liver damage accelerates
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  The presence of steatosis with inflammation and liver cell necrosis (NASH) NAFLD is a collection of liver diseases, from steatosis (ie fatty liver infiltration) to non-alcoholic steatohepatitis or NASH to cirrhosis (Figure 1)
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Figure 1 The comorbidities, genetic factors and environmental factors in the NAFLD disease spectrum are all related to the evolution of NAFLD and NASH
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The black font is a risk factor for the progress of NAFLD and NASH; the green font is a protective factor
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NASH is a more dangerous liver injury, which can lead to liver fibrosis, cirrhosis and advanced liver disease, and has a higher mortality rate
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        The presence of fibrosis with liver fibrosis, especially advanced fibrosis (stage 3 and 4) is a key prognostic marker for liver-related outcomes and overall mortality
.

A meta-analysis of 13 studies (including 4428 NAFLD patients) showed that compared with people without fibrosis, all-cause mortality in patients with stage 4 fibrosis (cirrhosis) [relative risk (RR) 3.
42, 95 %CI 2.
63–4.
46] is much higher, especially for liver-related mortality (RR 11.
13, 4.
15-29.
84) [2]
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2 ways to minimize the damage of NAFLD So, for patients who already have NAFLD, is there a way to minimize the damage of NAFLD? This is also true
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To understand the problem of how to reduce the harm caused by NAFLD, we should first see what is the biggest cause of the harm caused by NAFLD and the death of the patient
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According to investigations, although NAFLD brings a great burden to the liver, cardiovascular diseases and malignant tumors are the main causes of death in NAFLD patients
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Therefore, for the management of NAFLD, "the whole is greater than the local", the focus should not be limited to reducing liver damage, but should strive to minimize cardiovascular risks and reduce the driving factors of steatosis and systemic inflammation
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To do this, we must start from two aspects, and the editor will also help you organize it! 1 From the overall point of view: weight loss no matter what weight loss method is adopted: weight loss of 5%-7% or more can reduce liver fat content and alleviate steatohepatitis; if weight loss exceeds 10%, most patients will have liver fibrosis It has also been reversed
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In addition, for severely obese people, bariatric surgery can lose at least 15%-25% of the body weight, and the effect is sustained, which can improve liver fibrosis and NASH histologically
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However, due to the risks associated with any surgery, this method should not be used as a first-line management method
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2 From a local perspective: The drug treatment guidelines believe that drug treatments such as vitamin E and pioglitazone may be used in the treatment of some patients with NASH [3]
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However, vitamin E can increase the risk of bleeding, and higher doses may lead to adverse cardiovascular outcomes.
Potential adverse reactions should be considered before use
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In addition to the two drugs mentioned above, these drugs can also be used as off-license drugs
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But remember to take it under the guidance of a doctor after consulting a doctor! Table 1 Summary of Drug Therapy Off-NALFD Label Finally, the editor here reminds you that obesity is the main driving factor of NAFLD and is closely related to related metabolic comorbidities
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No matter what progress the new drugs have made now and in the future, a healthy life>Reference materials: [1]JL Wei,JC Leung,TC Loong,et al.
Prevalence and severity of nonalcoholic fatty liver disease in non-obese patients:a population study using proton-magnetic resonance spectroscopy Am J Gastroenterol,110(2015), pp.
1306-1314.
[2]RS Taylor,RJ Taylor,S Bayliss,et al.
Association between fibrosis stage and outcomes of patients with nonalcoholic fatty liver disease: a systematic review and meta-analysis Gastroenterology,158(2020),p .
1611,25.
e12[3]SL Friedman,BA Neuschwander-Tetri,M Rinella,AJ SanyalMechanisms of NAFLD development and therapeutic strategies Nat Med,24(2018),pp.
908-922.
[4]Elizabeth E Powell,Vincent Wai-Sun Wong,Mary Rinella.
Non-alcoholic fatty liver disease.
Lancet 2021;397:2212–24.