Fatty Liver Our liver suffers silently but with dramatic consequences

Improvements in the diagnosis and treatment of fatty liver disease

Non-alcoholic fatty liver is an extremely common complaint. Almost every third adult in the industrialized countries is affected, according to the German Center for Diabetes Research (DZD). Not infrequently, the disease remains undetected for a long time, but without proper treatment, serious consequences threaten, ranging from hypertension and type 2 diabetes to cirrhosis and liver cancer to a heart attack and stroke. Early countermeasures are therefore needed.

Often, the fatty liver diseases can be treated effectively by slight changes in lifestyle, but the condition is that the problem is recognized as such. However, many of those affected do not know that their liver is suffering. Because the symptoms often show up only in the later course of the disease. In a recent article by the journal "The Lancet Diabetes & Endocrinology", a team of authors with the participation of scientists from the German Center for Diabetes Research summarizes the current state of research and shows how personalized risk forecasts and individualized treatments can contribute to significant improvements in the future.

Many people suffer from fatty liver without knowing it. (Image: magicmine / fotolia.com)

Also obese children often have a fatty liver

"More and more adults but also about 34 percent of obese children suffer from non-alcoholic fatty liver disease (NAFLD)," said the DZD. As frequent causes, the experts call an "unhealthy lifestyle with little exercise and a lot of fat and sugar and fructose food and / or a genetic preload." The course of fatty liver disease could differ greatly among the individual affected, because the NAFLD form a very " complex and heterogeneous disease. "

Threatening sequelae

The threatening complications include severe liver damage, type 2 diabetes and cardiovascular disease and "to avoid these sequelae, the fatty liver must be detected in good time and the respective risk of liver, metabolic and myocardial diseases are accurately assessed," says the first author of the current article, Professor Norbert Stefan from the University Hospital Tübingen and the Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Zentrum München.

Research status evaluated for fatty liver

Together with Professor Hans-Ulrich Häring, also from the University Hospital Tübingen and the IDM, as well as Professor Kenneth Cusi from the University of Florida (USA), Prof. Stefan has evaluated the state of research and put it together in a review article. For example, not only patients with elevated liver enzymes should be screened for fatty liver, but also individuals with dysproportional fat distribution, i. a high proportion of belly fat and / or a small amount of fat around the hips and legs, emphasizes Professor Häring one of the research results.

Specific risk forecasts for those affected

In addition, the experts also recommend a fatty liver screening for people who suffer from insulin resistance or type 2 diabetes. In general, the use of new diagnostic and therapeutic approaches should be implemented in everyday clinical practice in order to enable a specific risk prognosis for possible secondary diseases, according to the researchers Prof. Stefan and colleagues. For example, a genetic NAFLD is associated with a higher risk of liver fibrosis and liver cancer. However, those affected have a low risk of cardiovascular disease. To take the right therapeutic measures, "it is important to know if a fatty liver is genetically determined," the experts emphasize.

Diagnosis of fatty liver disease

First of all, the question arises as to how fat levels in the liver can be reliably determined and how liver damage such as inflammation and fibrosis can be reliably detected. According to the physicians, "the use of simple indices or ultrasound examinations is suitable for primary care." In addition, the use of further examination methods such as special magnetic resonance imaging (MRI) by specialist physicians such as hepatologists, endocrinologists and radiologists is possible.

Lifestyle changes often enough

If a fatty liver was found in the examinations, often a change of the lifestyle can already achieve significant positive effects. For example, with a decrease of about five percent in weight, the fat content in the liver is reduced by up to 30 percent, according to the DZD. The goal, however, should be a weight reduction of about ten percent to reduce the risk of liver inflammation and fibrosis.

The reduction of existing overweight counteracts fatty liver disease and at best reduces the risk of further complications. (Image: Kurhan / fotolia.com)

Medication

"If such a weight-loss can not be achieved or is insufficient to improve the NAFLD, pharmacological treatment should be considered," emphasizes Professor Cusi in the DZD press release. While there is no drug approved for NAFLD, under certain conditions, such as non-alcoholic fatty liver in combination with diabetes or obesity, it is possible to use specific drugs that have different effects on liver fat content, inflammation and fibrosis ", Says Professor Cusi. With the help of the new concepts, a personalized risk prognosis and an individualized treatment of non-alcoholic fatty liver will become possible in the future. (Fp)