کبد چرب؛ زنگ خطر چاقی و مقاومت به انسولین : دکترعلی جمشیدی‌فرد، فوق تخصص غدد درون‌ریز و متابولیسم

Fatty liver; a warning sign of obesity and insulin resistance Fatty liver is often asymptomatic and is discovered incidentally on ultrasound; but is it only seen in obese people? What is the connection between insulin resistance, diabetes, and abdominal obesity? Can fatty liver lead to fibrosis and cirrhosis? In this interview with Dr. Ali Jamshidifard, a specialist in endocrinology and metabolism at Erfan Niayesh Hospital, we discuss the causes, risk factors, methods of diagnosing and treating fatty liver, and its relationship to obesity and insulin resistance. What is fatty liver? Fatty liver occurs when excess fat accumulates in liver cells. The new term is “metabolic-associated fatty liver disease,” or MASLD, which was previously known as nonalcoholic fatty liver disease, or NAFLD. This disease is usually associated with factors such as overweight, abdominal obesity, insulin resistance, prediabetes, type 2 diabetes, high blood pressure and dyslipidemia. What is the role of insulin resistance? In insulin resistance, muscle, fat and liver cells do not respond properly to insulin. To compensate, the body produces more insulin, which can increase the accumulation of fat in the liver. Fatty liver is not just a liver problem and can be a sign of a wider metabolic disorder. For this reason, it is also important to assess sugar, blood pressure, blood lipids, weight and waist circumference. Do only obese people develop fatty liver? No. Abdominal obesity increases the risk; but people of normal weight can also develop fatty liver. Genetic factors, body composition, nutrition, inactivity, some medications and underlying diseases also play a role. What are the symptoms of fatty liver? Most people do not have specific symptoms. Sometimes fatigue or discomfort in the upper right abdomen can occur. Jaundice, leg swelling, fluid buildup in the abdomen, gastrointestinal bleeding, or confusion can be signs of advanced disease and require immediate evaluation. Is fatty liver dangerous? In many people, there is only a buildup of fat; however, in a subset of patients, inflammation and cell damage also occur, called metabolic-associated steatohepatitis, or MASH. Persistent inflammation can lead to fibrosis, cirrhosis, liver failure, or liver cancer. The degree of fibrosis, or scar tissue, in the liver is important in predicting risk; therefore, focusing solely on the ultrasound result is not enough. How is fatty liver diagnosed? The doctor will review your medical history, weight, comorbidities, medications, and alcohol consumption. Liver function tests, blood sugar, and lipids, and may be needed to evaluate other causes. Normal liver enzymes do not completely rule out fatty liver or fibrosis. Ultrasound can show fat accumulation, but it does not accurately determine the severity of inflammation and fibrosis. Your doctor may calculate a FIB-4 score and perform elastography or fibroscan in high-risk individuals. A liver biopsy is only necessary in certain circumstances. How is fatty liver treated? The basis of treatment is lifestyle modification and control of metabolic factors. Gradual weight loss, a balanced diet, limiting sugary drinks and highly processed foods, regular physical activity, adequate sleep, and control of diabetes, blood pressure, and blood lipids can help improve liver and heart health. In people who are overweight or obese, losing about 3 to 5 percent of their weight can reduce liver fat. A larger weight loss of about 7 to 10 percent may be needed to reduce inflammation and fibrosis. Weight loss should be gradual and monitored, as extreme diets, malnutrition, and rapid weight loss may be harmful. Weight loss or diabetes medications may be appropriate for some patients. Specific treatment is also considered for certain groups with MASH and moderate to advanced fibrosis. The choice of medication depends on the stage of the disease and the individual's condition, and no medication or supplement should be taken arbitrarily. Is fatty liver reversible? In the early stages, weight loss and control of metabolic factors can reduce liver fat and inflammation and sometimes improve fibrosis. However, advanced cirrhosis may not be reversible; therefore, early diagnosis and assessment of the risk of fibrosis are very important. If your ultrasound shows fatty liver, you have abnormal liver enzymes, or you have abdominal obesity, prediabetes, diabetes, or dyslipidemia, see your doctor for a complete evaluation and determination of your risk of fibrosis. This video was prepared with the presence of Dr. Ali Jamshidifard, a specialist in endocrinology and metabolism, at Erfan Niayesh Hospital. This program is to raise public awareness and is not a substitute for examination, diagnosis, or advice from a doctor. Follow the channel and ring the bell to watch scientific videos about fatty liver, diabetes, obesity and endocrine diseases. #FattyLiver #Obesity #InsulinResistance #Diabetes #Prediabetes...