Fatty liver disease explained

Non-alcoholic fatty liver disease (NAFLD) refers to the excessive accumulation of lipids (triglycerides) in the liver cells, hepatocytes. Fat accumulation in the liver occurs when consumption of fats and sugars is too high. Hepatic steatosis occurs when this accumulation of fat represents more than 5% of the liver. NAFLD can progress to non-alcoholic steatohepatitis (NASH = fatty accumulation + inflammation + scar tissue/fibrosis), cirrhosis (distortion of the structure of the liver due to the majority of scar tissue) and liver cancer.

The causes

As the name suggests, NAFLD is not caused by excessive alcohol consumption. In Canada, obesity is the leading cause of fatty liver disease. Other causes include metabolic abnormalities (excess weight, insulin resistance, diabetes, high blood fat levels), toxins and certain medications (e.g. corticosteroids).

Many people with NAFLD have excess weight (obesity), type 2 diabetes (or glucose intolerance), dyslipidemia (high triglyceride and/or cholesterol levels), and/or metabolic syndrome (waist circumference). significant, hypertension, abnormal fasting blood sugar or insulin resistance and dyslipidemia).

Metabolic syndrome causes a buildup of lipids in liver cells because the body produces more lipids or eliminates them more slowly.

Many people with NAFLD do not have symptoms (asymptomatic). Some individuals experience fatigue, feeling unwell, or discomfort in the right side of the abdomen. The volume of the liver tends to increase.

The treatment

Treatment aims to eliminate or control potential causes and risk factors. This may include:

• Lose weight gradually and sustainably;
• Treat dyslipidemia (lower triglyceride levels);
• Treat hyperglycemia (improve blood sugar control and diabetes);
• Stop certain medications;
• Avoid consuming alcohol.

A reduction of:

• 5% of body weight can reduce lipid content in the liver;
• 7% of body weight can reduce inflammation and NASH;
• 10% of body weight can help remove scar tissue and fibrosis (Manuel Merck, 2023).

Nutritional recommendations

Adopting a healthy lifestyle (diet, exercise, sleep) can help prevent obesity, the main cause of non-alcoholic fatty liver disease.

In terms of diet, consuming too much sugar and fat can have a similar effect to excessive alcohol consumption and lead to fat accumulation in the liver. There is no specific diet for the liver, but here are some recommendations from the Canadian Liver Foundation that can contribute to better functioning of this essential organ.

1. Follow WHO recommendations by limiting the consumption of free sugars to less than 10% of total energy intake, i.e. 50 g per day for a 2000 calorie diet. To reduce your consumption of free sugars: drink water rather than sugary drinks, choose unsweetened dairy products, favor minimally or unprocessed foods, etc. ;
2. Eat small, regular meals. Do not skip meals or overeat;
3. Drink enough water;
4. Opt for whole foods: fruits, vegetables, legumes, lean meats, whole grains, dairy products and sources of good fats (e.g. nuts, avocado, fish);
5. Consume more colorful fruits and vegetables, rich in antioxidants essential for overall liver health;
6. Maximize the consumption of raw vegetables with a high sulfur content (e.g. broccoli, Brussels sprouts, cabbage, cauliflower, garlic and onion). Sulfur compounds have anticancer potential;
7. Wash fruits and vegetables before consuming them to eliminate pesticides;
8. Steam or bake vegetables, as this retains more nutrients than boiling;
9. Moderate the consumption of saturated fats and simple sugars. High intakes of sugar (fructose), sugary drinks and foods high in saturated fat have been associated with an increased risk of developing fatty liver;
10. Drink black coffee (2 to 3 cups per day). Studies have shown that coffee may be hepatoprotective;
11. Consume dairy products or alternatives enriched with vitamin D to meet the needs for this vitamin. This is important for promoting liver health.
12. Choose whole grains rather than refined grains;
13. Consume citrus fruits (the zest in particular can protect against the deposition of fat in the liver).

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