Liver

One consequence can be the non-alcoholic fatty liver disease (NAFLD), which includes a spectrum of liver diseases. NAFLD can be associated with type 2 diabetes, lipometabolic disorders and generally high levels of body fat. But metabolically healthy normal-weight people are also affected. The combination of low muscle mass and high abdominal fat is usually a risk factor. The patients appear slim from the outside and the body mass index (BMI) is below 25, which is within the range of normal weight. However, the BMI does not take into account the ratio of fat and fat-free mass or muscle mass. But this is exactly the problem of many apparently slim fatty liver patients. A sedentary lifestyle with little physical activity, coupled with a high-carbohydrate diet, leads to a dangerous redistribution of body mass without necessarily causing obesity.

The body stores excess fat in the liver cells. The hepatocytes inflate as a result, and in severe cases the liver swells to twice its volume. Unlike other organs, however, the diseased liver usually causes few problems. Occasionally, there is a pain of tension in the right upper abdomen, but a typical clinical picture usually only appears when irreversible damage has already occurred. Increased liver values can give the doctor clues to the disease, but a fatty liver is often an incidental finding during an ultrasound examination. The doctor can determine how advanced the disease is by taking a biopsy. Factors such as alcohol abuse, hepatotoxic medication or relevant previous illnesses should be clarified in the medical history.

Fatty liver in itself is not yet a health problem. However, the liver is damaged at the latest when the organ becomes inflamed (non-alcoholic fatty liver disease, NASH). Experts estimate that about 10 percent of people with NAFLD also develop steatohepatitis. This inflammation rapidly progresses the disease. Liver cells continually die and fibrous scar tissue forms. The initially swollen organ shrinks and the liver cells lose their function. Finally, cirrhosis will result. This stage is irreversible and increases the risk of hepatocellular carcinoma (HCC). However, liver cancer can also occur in NASH without cirrhosis having developed first. Fatty liver is therefore not to be taken lightly. The good news is that it can completely disappear if treated early and consistently.

So far, there is no drug therapy. Instead, the respective cause must be found and addressed in each individual case. For most people, this means adjusting their lifestyle, because a noticeable number of those affected consume plenty of sugared soft drinks and sweets in their daily lives. What helps then is a change to a Mediterranean diet and the renunciation of carbohydrates. In doing so, special attention should be paid to eliminating fructose-containing and glucose-fructose-containing drinks from the diet. If people of normal weight also lose about five percent of their body weight, the liver often responds with a recovery. In any case, exercise is part of this process; at least half an hour of exercise three times a week is recommended. The choice of sport is up to you and depends on your personal preferences and basic fitness level. The important thing is that the dietary and exercise goals seem achievable and that patients stay on the ball.

The liver is the only organ that can completely regenerate its cell mass within a few weeks, even if more than half of the organ has been destroyed or removed. Where this regenerative ability is coming from has not yet been fully researched. Experimental studies indicate that possibly the increased blood flow and the mechanical expansion of the blood vessels in the reduced or damaged liver are triggers. This causes more growth signals to be released such as hepatocyte growth factor (HGF). Once the liver has returned to its normal size, blood flow returns to normal and growth stops. However, the more advanced the stage of NAFLD, the more difficult it is for the liver to recover. Fibrosis can only be reversed to a limited extent, while in cirrhosis the functional liver tissue is lost for good.