28-year-old Xiao Liu is a slim girl, but was diagnosed with fatty liver in a routine physical examination, Xiao Liu is very puzzled, obviously he is a "thin man", and other indicators such as liver and blood lipids are also very normal, why is there fatty liver? So I changed to another hospital for examination, and I got the same diagnosis, fatty liver. After communicating with others, Xiao Liu found that there were still many people in the same situation as himself, what was going on?
In fact, fatty liver is not the patent of "fat people", thinner people, the influence of long-term unhealthy lifestyle or the role of genetic factors, will lead to such people to suffer from fatty liver. That is, it is usually said to be "lean people's fatty liver".
First, what is lean people's fatty liver?
According to the body mass index formula (BMI = body weight (kg) / height (m) ²), BMI >23 is overweight, BMI >30 is obesity, the so-called lean fatty liver is BMI<23 people with fatty liver. We usually say that fatty liver refers to "non-alcoholic fatty liver disease", also known as "metabolism-related fatty liver disease", "thin" fatty liver incidence in the general population is 5.1%, accounting for about 1/5 of the fatty liver population.
For the pathogenesis of fatty liver, it is now widely accepted that the theory of "secondary blow", that is, the use of glucose caused by insulin resistance is blocked to force lipolysis to supply energy, so that the free fatty acids in the blood are elevated, and if there is a lack of enzymes and vitamins related to lipid metabolism, it will lead to fat retention in the liver, forming the first blow. The second blow is an oxidative stress response, which is an inflammatory response induced by reactive oxygen species that occurs within liver cells on the basis of the first blow.
Second, why do thin people get fatty liver?
In the past, when it comes to fatty liver, we always think of "fat people" with big stomachs and poop, and always think that this disease has little to do with "thin people", but in fact, thin people will also get fatty liver. The main reasons are as follows:
1. Insulin resistance: insulin resistance is an important trigger for the occurrence of fatty liver, which leads to an increase in free fatty acids in the blood and then deposited in the liver. Even in the absence of other metabolic risk factors, insulin resistance can lead to fatty liver.
2, eating habits: eating habits and the development of "thin people" fatty liver seems to be related, high-sugar and high-fat diet is more common in "thin" fatty liver patients, and high-sugar and high-fat diet further increases the liver burden so that fat accumulation forms fatty liver.
3. Genetic susceptibility: genetic factors have been confirmed to be associated with obesity and non-alcoholic fatty liver disease, and play a more significant role in "thin" fatty liver disease.
4. Visceral and ectopic obesity: visceral obesity may play an important role in the pathogenesis of lean fatty liver, obesity is the main cause of free fatty acid increase, steatosis, inflammation and fibrosis mediators. Even in the absence of peripheral and visceral obesity, ectopic accumulation of intracellular lipids in muscles and liver can lead to the development of insulin resistance, which can induce nonalcoholic fatty liver disease.
5. Intestinal microbiota disorder: intestinal microbiota can affect the formation of fatty liver through inflammatory response, short-chain fatty acid metabolism and bile acid metabolism. There is no "body preference" for the onset of fatty liver, "thin people" and "obese types" may suffer from fatty liver, and even some factors have a more obvious effect on "thin people".
Third, what are the harms of fatty liver in thin people?
"Thin" fatty liver patients are usually asymptomatic, and their weight and abdominal circumference are lower than those of "obese" fatty liver patients, but they are less perceptible. Long-term fat accumulation in liver cells can lead to steatohepatitis and liver fibrosis, which are important pathological changes in the direction of fatty liver development into cirrhosis and liver cancer. Long-term follow-up studies have shown similar incidence and all-cause mortality in patients with "lean" fatty liver and cirrhosis, diabetes, cardiovascular disease, and malignancies inside and outside the liver in patients with "obese" fatty liver disease. Therefore, the harm of "thin" fatty liver and "obese" fatty liver is not the same, and it also needs to be paid attention to.
4. How to treat fatty liver in thin people?
1. General treatment:
Adjust the diet structure: the principle is low carbohydrate, low fat, sufficient amount of protein, increase the daily diet of vegetables, fruits. Long-term adherence is required, and thin people with non-alcoholic fatty liver disease often have recent weight gain, and they should also reduce weight appropriately.
Proper exercise: Proper exercise reduces liver fat content while improving insulin resistance and inhibiting the synthesis of free fatty acids, with a beneficial effect.
2. Drug treatment:
If general treatment based on lifestyle interventions does not improve the patient's condition, drug therapy should be used for different causes and symptoms of the patient, including antioxidant therapy, insulin sensitization therapy, and treatments such as lipid-lowering, hypoglycemic, antihypertensive, and hepatoprotective therapy, but there is no clear effect of drug recommendations.
Thin people also have a risk of fatty liver, its harm is no less than that of obese fatty liver, regular liver B ultrasound examination helps to find early liver steatosis, once it appears, it needs to be actively treated. General treatment based on lifestyle interventions is at the heart of the prevention and treatment of fatty liver disease in lean people, but requires patients to have high compliance.