Fatty liver disease is generally benign, but may in some cases progress to steatohepatitis, a form of hepatitis caused by the fat deposition in the liver. The steatohepatitis is a more severe form of fat accumulation that hepatic steatosis, it may lead, in the long term, the destruction of liver tissue, scarring of the liver and the development of cirrhosis.
There are several causes of hepatic steatosis and steatohepatitis, and excessive alcohol consumption, obesity and diabetes the key.
The hepatic steatosis is a problem that, if not properly controlled, may progress to steatohepatitis and eventually to cirrhosis. But, fortunately, only a minority of patients with fatty liver ends up developing cirrhosis.
As a silent disease, causing no symptoms, the exact number of people suffering from fat accumulation in the liver ends up being underestimated. It is believed that up to 1 in 3 people may have steatosis. The lack of an exact number of people with the disease makes it difficult to estimate what percentage of these evolve to long-term cirrhosis. In general, less than 10% of patients with end steatosis to steatohepatitis evolving. Of those, 20% will progress to cirrhosis.
Therefore, despite the steatosis is a benign disease in most cases, if left untreated, it is possible that the disease evolved unfavorably. Therefore, all patients diagnosed with hepatic steatosis and especially steatohepatitis should start specialized treatment to reverse this accumulation of fat.
Treatment of hepatic steatosis and steatohepatitis
Multiple treatments have been investigated for the control of hepatic steatosis. But few have scientifically proven results. Let's summarize the main steps that can be taken to treat steatosis.
Weight loss
The most effective measure to control hepatic steatosis is weight loss. Studies show that a reduction of only 7% in body weight may be able to bring excellent results. So an obese or overweight person who weighs around 80 kilos, would need to lose about 5 kilos to be able to present regression of liver fat accumulation.
In general, we suggest physical activity and control of consumption in order of calories the patient to lose between 0.5 and 1 kg per week. very fast weight loss caused by very strict diets, can have the opposite effect, aggravating the steatosis. No need to rush. A slow weight loss, but ultimately, is the best way to combat steatosis.
The weight loss, of course, works only for those obese or overweight individuals. Persons with body mass index (BMI), ie between 20 and 25 kg/m2, did not have great benefit, since the cause of his steatosis is not excessive body fat.
Drinking
The suspension of alcohol consumption is extremely necessary to prevent a steatosis evolve to steatohepatitis and liver cirrhosis. People with liver fat accumulation signs should avoid completely alcohol.
Probably small amounts of alcohol ingested sporadically, should do no harm, but do not know the minimum safe dose in these cases. As many patients with steatosis caused by alcohol are used to drink large amounts of alcohol, the ideal is to educate them to avoid drinking altogether.
Cardiovascular disease
Patients with NAFLD are at increased risk of cardiovascular disease, so the control of risk factors is essential to decrease the risk of cardiac complications. Weight loss, practicing physical activity, control of blood pressure levels, stop smoking and use of statins (drugs to control cholesterol) are measures that should be instituted when necessary.
The use of medication to control cholesterol does not act directly on the steatosis, but helps to reduce the cardiovascular risk of these patients. If the patient has high cholesterol, the presence of steatosis is another reason for its control with medication.
Vaccination for hepatitis A and B
Patients with steatosis and especially steatohepatitis had unfavorable outcomes, should they become infected with any of the forms of viral hepatitis. Therefore, for those who are not immunized indicated vaccination against hepatitis A and hepatitis B.
Vaccination has no effect on steatosis, it only serves as protection against further liver problems.
There is still no vaccine for hepatitis C.
Suspend harmful drugs
If the patient starts to accumulate fat in the liver as a side effect of medications such as corticosteroids, estrogen, tamoxifen, amiodarone, etc., treatment should, whenever possible, aim the suspension of these drugs.
Unfortunately, the measures that are proven to benefit patients with fatty liver are only described in the previous section. Dozens of drugs have been studied for the treatment of steatosis, but none of them has so far managed to gather substantial scientific evidence so that we can affirm its effectiveness and indicate them specifically for treatment.
Let's summarize the results of the drugs most studied for steatosis and steatohepatitis.
Vitamin E
Studies of vitamin E have shown conflicting results. Currently, there is a consensus that for simple steatosis, vitamin E does not have any advantage. However, patients with steatohepatitis and liver fibrosis signals proven by liver biopsy appear to benefit from treatment with 400 to 800 IU of vitamin E per day.
Oral antidiabetic
Hypoglycemic drugs such as metformin, pioglitazone, and rosiglitazone commonly used treatment of type 2 diabetes has been studied as an alternative for the treatment of steatosis. However, no studies have proven the effectiveness of these drugs in patients with steatosis without changes in blood glucose.
Therefore, these drugs should not be used for the treatment of steatosis, unless the patient is diabetic and has an indication for treatment with oral hypoglycemic agents.
Orlistat
Studies have shown that the beneficial effect of orlistat is directly related to weight loss of the patient. The drug does not act directly on the steatosis. Therefore, orlistat can be used in the treatment of steatosis only as an auxiliary drug for the control of body weight.
Omega 3
Some studies have shown benefits of omega 3 in the cases of steatosis, but not of steatohepatitis. Patients with high triglycerides also seem to benefit. However, more conclusive studies are needed before we can indicate the omega 3 as an effective treatment for hepatic steatosis.
Several other drugs have been tested in several studies, but always with mixed results. Among them we can mention:
There is no specific diet for patients with steatosis. However, its power must be balanced in order to facilitate weight loss, diabetes control and cholesterol. The patient must therefore avoid frying fats and excess sweets.
Diets high in saturated fat, trans fat and excess sugar have been associated with an increased risk of development of fat in the liver. Drinks and foods high in fructose (soft drinks and sweets in general) also appear to be harmful.
Fruits, cereals, vegetables, polyunsaturated fats are healthy foods that should be part of the diet of anyone, but especially diabetics, cardiac patients and individuals with steatosis.
If you like a lot of bread, give preference to bread. skim milk and low-fat cheeses are the most suitable. Among the meats, the fish is the best, especially salmon, tuna and sardines.
