Non-alcoholic fatty liver disease (NAFLD) is a lesion of the corresponding organ against the background of low alcohol consumption (up to 30 g per day in men, up to 20 g per day in women). The prevalence of NAFLD is high throughout the world – pathology is detected in 20-33% of the adult population. NAFLD affects more than 30% of people, being the most common liver disease.
Causes, symptoms, diagnosis
The cause of NAFLD is the excessive accumulation of fats and other derivatives of cholesterol in the liver cells. This is a consequence of the imbalance between their formation and utilization. The risk of NAFLD is higher in those with obesity, diabetes mellitus, dyslipidemia, and metabolic syndrome. To a lesser extent, it increases in patients with vitamin D deficiency, polycystic ovaries, hypothyroidism, and some rare endocrine diseases.
The disease proceeds in 3 stages:
- steatosis (fatty liver);
- steatohepatitis (inflammation of the liver);
- cirrhosis (actually – the destruction of the liver).
The problem with this pathology is that it proceeds for a long time without symptoms. Only a small proportion of patients go to the doctor with complaints of fatigue and aching pain in the upper right abdomen. In the rest, NAFLD is discovered incidentally during examinations for other diseases.
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Severe symptoms appear only at the final stage of NAFLD, when the liver is destroyed and can no longer perform its functions.
With NAFLD, the level of several indicators increases in the blood: ALT, AST, GGT (gamma-glutamyl transpeptidase), alkaline phosphatase and bilirubin. Changes in the structure of the liver can be seen on ultrasound. To establish an accurate diagnosis, a biopsy is performed – the most accurate study. Its results do not always match the blood tests. With elevated ALT, half of the patients do not have fatty liver, but one in three with a normal ALT level is diagnosed with NAFLD based on biopsy results.
Who needs treatment
Treatment is necessary for all patients, since NAFLD in the final stage leads to the destruction of the liver and increases the likelihood of cancer. Even the initial forms of the disease are dangerous: they are accompanied by elevated levels of cholesterol, triglycerides in the blood, and therefore increase the risk of atherosclerosis and severe cardiovascular diseases.
The main treatment options are weight management, diet, physical activity. If this is not enough, drugs come to the rescue.
There are not many drugs that could slow down the development of steatohepatosis. Basically, doctors use hepatoprotectors, including ursodeoxycholic acid, statins and fibrates to improve lipid metabolism, vitamins and hypoglycemic agents.
The use of UDCA in fatty liver
Study of the Liver published the results of the SUCCESS study, which evaluated the effect of ursodeoxycholic acid (UDCA) preparations on the course of NAFLD in 207 patients. The subjects took Ursosan at a daily dose of 15 mg/kg for 6 months. It turned out that UDCA reduces ALT, AST and GGT. It not only prevents fibrosis and cirrhosis of the liver, but also reduces cardiovascular risks.
The researchers assessed lipid metabolism, as well as the thickness of the intima-media complex (IMCT) of the carotid artery, which reflects the severity of atherosclerosis. An increase in IMT for every 0.1 mm increases the risk of myocardial infarction by 10-15%, stroke – by 13-18%. The study showed that UDCA lowers blood levels of triglycerides and “bad” cholesterol, and also reduces IMT. Due to these effects, the drug reduces the risk of developing severe cardiovascular diseases over the next 10 years.
The results of the SUCCESS study were highly appreciated internationally. They were published in the World Journal of Gastroenterology, which is one of the most prestigious and rated in the world. This journal publishes only original research that is of great importance for world medicine.
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