Don’t let obesity become the accomplice of liver cirrhosis

In recent years, with the development of social economy and the change of life style, the incidence rate of viral hepatitis and alcoholic liver disease has decreased, but the incidence rate of obesity related liver disease has been rising, and the onset of disease has gradually become younger. In developed countries and regions such as Australia, Japan, Europe and the United States, increasing obesity has become the primary cause of chronic liver disease and an important accomplice to viral hepatitis, alcoholic liver disease, drug and toxic liver disease. Scientific and reasonable weight loss can reduce the occurrence of liver disease, prevent the progress of liver disease and prevent the recurrence of liver disease. Therefore, to protect the liver, we should first pay attention to body weight and waist circumference.

obesity is closely related to liver disease

In the past, people only noticed that underweight (emaciation) can lead to dystrophic fatty liver. However, in recent years, more and more obesity related malnutrition fatty liver have been seen in bed. A large number of epidemiological investigations show that obesity is the main cause of abnormal liver function enzymes in healthy children and adults, and more than two-thirds of the increase in serum aminotransferase is related to obesity; The relationship between obesity and fatty liver is closer than that between alcohol consumption and fatty liver. At present, the increasing number of fatty liver is mainly non-alcoholic fatty liver related to obesity, while alcoholic fatty liver only accounts for 5% ~ 10%; Even without other concomitant diseases, the incidence of nonalcoholic fatty liver is very high in obese people. About 56% ~ 78% of obese people have fatty liver, and 21% ~ 39% have nonalcoholic fatty hepatitis. The incidence of liver cirrhosis in the latter 10 years is 20%, and the mortality related to liver disease is 12%. The causes of death include liver failure and hepatocellular carcinoma. For this reason, although the severity of obesity’s harm to the liver has not yet emerged, with the passage of time, obesity related liver disease is expected to replace hepatitis B and alcoholic liver disease and become the first major liver disease causing liver related disability and death.

As the saying goes, “the fat body is weak, and the fat liver is vulnerable”. Obese patients are more intolerant to alcohol, drugs, industrial poisons, liver surgery and ischemia related liver injury than normal weight people. Obesity is an important risk factor for alcoholic cirrhosis and cryptogenic cirrhosis complicated with liver cancer.

Moreover, obesity and its accompanying fatty liver can promote the progress of liver fibrosis in chronic viral hepatitis, and affect the effect of interferon on the antiviral treatment of chronic hepatitis B and C, resulting in an increase in the incidence of liver cirrhosis and liver cancer. In addition, obesity can lead to the recurrence of steatohepatitis after liver transplantation, the nonfunction of primary transplanted liver and the reduction of its postoperative survival time.

Therefore, for obese people, in addition to thinking that they are prone to diabetes, coronary heart disease and stroke, there are also many liver disease related events in obese people. Some studies in Japan even reported that obese diabetes patients are far more likely to die of cirrhosis than stroke.

Clinically, overweight and obesity are usually judged by standard body weight, body mass index and waist circumference. In different ages, genders and races, the judgment standards of obesity are not uniform. Clinical studies have found that in the formation of obese fatty liver, the possible cause is not weight gain in the general sense but waist circumference enlargement. The relationship between visceral obesity (Apple type obesity) and fatty liver is more important than subcutaneous obesity (pear type obesity).

Compared with European and American people, Chinese people are less tolerant of obesity; Compared with normal people, patients with viral hepatitis can not tolerate weight gain. For the former thin people, the adverse effects of rapid weight gain and waist circumference enlargement on the liver in the short term are the same as those of obesity, which may explain that about 20% of patients with nonalcoholic fatty liver are not overweight.

preventive measures for obese liver disease

It is well known that “one fat brings many diseases”. Therefore, if you want to live a long and healthy life, you need to control your weight and waist circumference. Both normal people and patients with liver diseases should keep their ideal weight as much as possible, avoid excessive accumulation of fat, and especially prevent visceral obesity with enlarged waist circumference. Remember that “it is easy to gain weight but difficult to lose weight”. For some thin children and young people, it is not that they will not gain weight but that the time has not come. Therefore, all kinds of health care measures and treatment options can not be at the cost of excess calories and obesity.

Alcoholism can induce visceral obesity (spleen, alcohol and abdomen) and related liver damage. Patients with obesity combined with fatty liver or liver function damage must abstain from alcohol, because there may be no safe drinking dose at all; Obese patients should use hepatotoxic drugs with caution and reduce the chances of exposure to hepatotoxic substances as much as possible; Obese patients with hyperlipidemia should emphasize the importance of changing their lifestyle, strictly grasp the application indications of lipid-lowering drugs, and appropriately reduce and add liver protecting drugs when necessary.

Clinically, many patients with viral hepatitis are not cured because of viral infection but obesity related liver disease. Therefore, asymptomatic chronic hepatitis B virus infection (“hepatitis B surface antigen carriers”) or patients with various types of viral hepatitis should change the wrong view of overemphasizing “nutrition and rest”, so as to avoid excessive weight growth in the near future inducing post hepatitis fatty liver.

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