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Non-alcoholic fatty liver disease is multifactorial, with a possible genetic component fomenting it’s appearance in some patients. There are certain genetic variations (polymorphisms) that promote the production of fat or hinder its transport out of the liver; leading to accumulation. Studies where the genetic causes have been determined show that patients with these genetic variations evolve more quickly, but there are usually other causes too, such as diabetes or obesity.
The individual risk for each patient of developing cirrhosis cannot be known. It is known that 25-30% of the world population has fat in the liver. However, only about 20% of these patients are at risk of progression to more advanced stages with inflammation and fibrosis. Of this 20%, 15-20% will progress to cirrhosis.
It is recommended not to drink alcohol. Alcohol can add toxicity to an already damaged liver with fatty deposits leading to faster progression of the disease. Since a safe amount of alcohol cannot be established, the recommendation is not to drink.
Some drugs can cause accumulation of fat in the liver. These are called secondary causes of non-alcoholic fatty liver disease. Taking these drugs does not inevitably lead to cirrhosis, of course, but they can aggravate liver damage.
Always check if they are being taken and withdraw them, where feasible. If it is not feasible to withdraw the drug because it provides more benefits than harm, the fatty liver must be monitored and checked for fibrosis (scar tissue).
Patients who have fat in the liver, without inflammation or fibrosis (scar tissue), can be followed up from primary care. The objective in these patients is to follow a Mediterranean diet, do physical exercise and have an analytical check-up every 2-3 years to assess whether there are signs of fibrosis or progression. However, patients with advanced fibrosis will have to follow up with the hepatology or gastroenterology medical team to control the appearance of cirrhosis and its complications.
The Mediterranean diet is proven to be the best for avoiding fatty liver disease. This diet must be low in saturated fats and sugars. Saturated fats are found in red meat, sausages, butter and cream, for example; while sugars are found in alcohol, brown sugar, honey, chocolate, ice cream and sugary drinks, among others. The latter have a high content of fructose, which is mainly metabolised in the liver and promotes the synthesis of fats, so these products must be avoided. A glass of milk with the same number of calories as a sugary drink is always better, due to the latter’s fructose content. Total removal of this type of beverage with a high fructose content must be one of the main objectives.
Yes. Patients who lose weight and their liver fat disappears, including even fibrosis (scar tissue), may get the disease again if the risk factors that caused it return. Therefore, the diet and exercise changes recommended by specialists must be maintained and implemented regularly throughout life.
The ideal would be to combine aerobic physical exercise (e.g. running, cycling, swimming, dancing or skating) with anaerobic physical exercise (e.g. push-ups, sit-ups, planks and squats). However, this must be in accordance with the abilities and limitations of each person. Therefore, if aerobic physical exercise cannot be practised, only strength or resistance (anaerobic) exercises can be carried out. Choose just 6-8 exercises, perform 10-15 repetitions of each and repeat this series up to 3 times. This routine can last for 20-40 minutes. The exercises can be done at home with 1-2 kg weights, some elastic material and a mat. Yoga or pilates can also be practised.
If you eat only 1 meal a day or less than you need, the body stores all the calories and lowers the base metabolism when you eat food; that is, it reduces the energy it spends on carrying out all its physiological processes (to maintain the body). Therefore, you should have 3 main meals (breakfast, lunch and dinner) and 2 smaller, secondary snacks; eating more during the first part of the day and less before going to sleep. Also, in a single meal, half the plate should be occupied by a salad or vegetables, a quarter by carbohydrates (pasta, potato or rice) and the other quarter by protein (legumes, fish, white meat, eggs), although a vegetable source is preferable.
Carbohydrates are necessary for the energy our body needs to function; therefore, they should not be eliminated from the diet. To lose weight, you should limit carbohydrates to 4 servings a day. A serving of pasta or rice must be 60 g, bread 40 g and potatoes 150 g. At least one of these portions should be wholemeal.
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Substantiated information by:
Isabel Graupera Garcia-MilàHepatologist Senior SpecialistHepatology Service
Marta Cervera CarbonellNurseHepatology Service
Pere Ginès GibertHepatologistHepatology Service
Published: 19 August 2022
Updated: 26 August 2022
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