2023-12-10 06:00:32
[박효순의 건강직설]
Entered 2023.12.10 15:00 Views 1 Entered 2023.12.10 15:00 Modified 2023.12.10 14:53 Views 1
The prevalence and severity of non-alcoholic fatty liver disease not only in adults but also in children and adolescents has recently become a major problem as it has been increasing along with the increase in obesity. [사진=게티이미지뱅크]There is a ‘funny’ joke that in order to cure fatty liver disease (fatty liver), you just need to move from a rural area to a big city like the Seoul metropolitan area. In the past, alcohol was the biggest cause of fatty liver disease, where fat accumulates in the liver, but over the past few years, the prevalence of non-alcoholic fatty liver disease has been increasing. The prevalence of non-alcoholic fatty liver disease diagnosed by abdominal ultrasound among recent domestic health checkups was 16-33%.
According to the ‘Korean Liver Disease White Paper 2023’ published by the Korean Liver Association, the prevalence and severity of non-alcoholic fatty liver disease not only in adults but also in children and adolescents has recently been increasing along with the increase in obesity, emerging as a major problem. Non-alcoholic fatty liver disease in children and adolescents is also closely related to metabolic syndrome, including abdominal obesity, dyslipidemia, hypertension, insulin resistance, and impaired glucose tolerance. Not having enough time to exercise due to excessive study and dependence on smart devices, and frequent consumption of processed and instant foods, are also related to the development of fatty liver.
Although the results of each study are somewhat different, in general, 60-80% of obese people have non-alcoholic fatty liver disease, and 25-40% of patients with non-alcoholic fatty liver disease progress to non-alcoholic steatohepatitis. Additionally, 5-18% of patients with non-alcoholic steatohepatitis progress to cirrhosis, and the annual cumulative incidence of hepatocellular carcinoma in patients with cirrhosis associated with non-alcoholic steatohepatitis is estimated to be 2.6%.
Treatment of non-alcoholic fatty liver disease is generally divided into lifestyle improvement, metabolic syndrome treatment, drug treatment for steatohepatitis or liver fibrosis, and treatment of complications such as cirrhosis related to non-alcoholic fatty liver disease. For most patients, the most important and cost-effective basic treatment method is lifestyle modification, such as weight loss through diet and exercise. In the treatment of non-alcoholic fatty liver disease, it is important to control accompanying insulin resistance, obesity, and hyperlipidemia. To treat these concomitant diseases, drug treatment for each is important, but above all, it is important to correct eating habits and exercise at the same time.
The liver disease white paper constantly emphasizes that weight loss through proper diet and increased exercise can improve non-alcoholic fatty liver disease. In the treatment of non-alcoholic fatty liver disease, reducing total energy intake is most important in controlling diet, and controlling carbohydrate and fat intake is especially important. Research results on whether a low-carbohydrate or low-fat diet is more important in the treatment of non-alcoholic fatty liver disease are inconsistent, but carbohydrate control is more important considering the domestic dietary pattern in which carbohydrate intake has a relatively higher proportion of total calories than fat. .
Exercise therapy helps improve insulin resistance and metabolic syndrome. Exercise therapy was associated with a decrease in the prevalence of non-alcoholic fatty liver disease regardless of abdominal obesity and insulin resistance among 3,718 people who underwent health checkups in Korea. Additionally, in the same study, when 1,373 people continued to exercise by maintaining or increasing exercise intensity, the incidence of non-alcoholic fatty liver disease decreased regardless of abdominal obesity and insulin resistance. Both aerobic exercise and muscle strengthening exercise are helpful, and can be especially effective if you have abdominal obesity or sarcopenia.
The obese population in Korea accounts for approximately 30-40% of the total population. Of these, 25-30% have non-alcoholic fatty liver disease. Approximately 30% of all non-alcoholic fatty liver disease patients have type 2 diabetes. In particular, non-alcoholic fatty liver disease is not limited to liver disease, but is a systemic disease associated with all metabolic organs of the body (brain, fat tissue, muscle tissue, pancreas, small and large intestine, blood vessels, thyroid gland, gonads, etc.). In the white paper, the Association of Liver Studies repeatedly warns, “There are concerns regarding an explosive increase in liver cirrhosis, hepatocellular carcinoma, cardiovascular disease, and metabolic complications caused by non-alcoholic fatty liver disease.”
The first step in treating non-alcoholic fatty liver disease is lifestyle modification. The government must increase people’s access to healthy food, protect people from unhealthy food marketing, and encourage healthy eating and physical activity. Additionally, it should be considered to actively reflect medical fees in lifestyle education for non-alcoholic fatty liver patients.
Consuming high-calorie foods accompanied by binge eating and excessive drinking increases the risk of obesity and non-alcoholic fatty liver disease. It will be necessary to develop diagnostic criteria for binge eating, guidelines for broadcasts and advertisements that encourage binge eating, and establish a monitoring system. Foods subject to mandatory nutrition labeling should be expanded to allow consumers to check the content of calories and carbohydrates (especially sugars) so that they can choose healthy foods. What is most urgent is to significantly strengthen the recommended daily sugar intake and insert warning statements.
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