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Improvements in diagnosis and treatment for fatty liver diseases
The non-alcoholic fatty liver is an extremely common complaint. Almost one in three adults in industrialized countries is affected, according to the German Center for Diabetes Research (DZD). It is not uncommon for the disease to go undetected for a long time, but without adequate treatment there are serious consequences, ranging from high blood pressure and type 2 diabetes to liver cirrhosis and liver cancer to a heart attack and stroke. Early countermeasures are therefore required.
Often, fatty liver diseases can be treated effectively by making slight lifestyle changes, but the prerequisite is that the problem is recognized as such. However, many of those affected do not know that their liver is suffering. Because the symptoms often show up later in the course of the disease. In a current article by the specialist magazine "The Lancet Diabetes & Endocrinology", a team of authors with the participation of scientists from the German Center for Diabetes Research summarizes the current state of research and shows how personalized risk forecasts and individualized treatments can contribute to significant improvements in the future.
Obese children also often have fatty liver
"More and more adults, but also around 34 percent of obese children, suffer from non-alcoholic fatty liver disease (NAFLD)," the DZD said. The experts cite common causes of an "unhealthy lifestyle with little exercise and a lot of fat, as well as food that contains sugar and fructose and / or a genetic pre-stress." complex and heterogeneous disease. "
Impending secondary diseases
The impending complications include severe liver damage, type 2 diabetes and cardiovascular diseases and "in order to avoid these secondary diseases, the fatty liver must be recognized in good time and the respective risk of liver, metabolism and heart muscle diseases must be precisely assessed," emphasizes the first author of the current technical contribution, Professor Norbert Stefan from the University Hospital Tübingen and the Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Zentrum München.
State of research on fatty liver evaluated
Together with Professor Hans-Ulrich Häring, also from the University Hospital Tübingen and the IDM, and Professor Kenneth Cusi from the University of Florida (USA), Prof. Stefan evaluated the state of research and put it together in an overview article. For example, not only patients with elevated liver enzymes should be examined for fatty liver, but also people with a disproportionate fat distribution, i.e. Professor Häring emphasizes one of the research results: a high proportion of belly fat and / or a low proportion of fat around the hips and legs.
Specific risk forecasts for those affected
The experts also recommend fatty liver screening for people who suffer from insulin resistance or type 2 diabetes. In general, the use of new diagnostic and therapeutic approaches in everyday clinical practice should be implemented in order to enable a specific risk forecast for possible secondary diseases, the researchers Prof. Stefan and colleagues continue. For example, a genetic NAFLD is associated with a higher risk of liver fibrosis and liver cancer. However, those affected have a low risk of cardiovascular diseases. In order to take the right therapeutic measures, "it is important to know whether a fatty liver is genetically determined," emphasize the experts.
Diagnosis of fatty liver disease
First of all, the question arises of how the amount of fat in the liver can generally be reliably determined and how liver damage such as inflammation and fibrosis can be reliably detected. According to the medical experts, "the use of simple indices or ultrasound examinations is suitable in primary care." In addition, if necessary, the use of further examination methods such as special magnetic resonance imaging (MRI) by specialist physicians such as hepatologists, endocrinologists and radiologists is possible.
Lifestyle changes are often sufficient
If a fatty liver was found in the investigations, a lifestyle change could often already have significant positive effects. For example, with a decrease of about five percent in weight, the fat content in the liver is reduced by up to 30 percent, according to the DZD. However, the goal should be to lose about ten percent of weight in order to reduce the risk of liver inflammation and fibrosis.
"If such weight loss cannot be achieved or is not sufficient to improve NAFLD, pharmacological treatment should be considered," Professor Cusi emphasized in the DZD press release. To date, no drug has been approved for NAFLD, but under certain conditions, such as the occurrence of non-alcoholic fatty liver in combination with diabetes or obesity, the use of specific drugs is possible, "which have different effects on liver fat, inflammation and fibrosis "Said Professor Cusi. With the help of the new concepts, a personalized risk forecast and individualized treatment of non-alcoholic fatty liver will be possible in the future. (fp)