Fatty Liver Can Lead to Cirrhosis and Liver Cancer; 40% of Fatty Liver Patients Are Not Obese

In the conventional understanding of most people, non-alcoholic fatty liver disease (NAFLD) is usually associated with obesity. But this "common sense" is actually wrong: it is not only fat people who have fatty liver; fatty liver is also very common among non-obese people.

A systematic review and meta-analysis recently published in The Lancet Gastroenterology & Hepatology analyzed data from 93 studies across 24 countries or regions, covering a total of 10.576 million subjects. It found that about 40.8% of fatty liver patients worldwide belong to the non-obese group, and about one-fifth of those are actually thin (the specific percentage is 19.2%).

This may sound counterintuitive, but it is the truth. Many people keep their figures in good shape yet still develop fatty liver. Monks and nuns eat vegetarian food all their lives, yet among them too, fatty liver patients are quite common.

Fatty liver is a precursor to cirrhosis and liver cancer. Non-alcoholic simple hepatic steatosis and non-alcoholic steatohepatitis (NASH) gradually cause liver fibrosis and may eventually progress to cirrhosis, liver failure, and even liver cancer. Among non-obese fatty liver patients, 39% have already progressed to NASH, 29.2% already have significant liver fibrosis, and 3.2% already have cirrhosis.

So obesity is not the only criterion for screening fatty liver. Middle-aged people, whether obese or not, should be screened for fatty liver regularly by ultrasound. Obese fatty liver patients can mostly reverse the condition through weight loss. But non-obese fatty liver patients cannot reverse fatty liver through weight loss. To date, Western medicine has no particularly good means of treating fatty liver; after most patients are diagnosed with fatty liver on a physical exam, they are told no treatment is needed, only to watch their diet and return for regular check-ups.

The author recently treated a patient with fatty liver accompanied by abnormal liver function. The patient was not obese and already had obvious abdominal distension, with liver stiffness at the critical value. The author suggested the patient take Shugan Hewei Wan (Liver-Soothing and Stomach-Harmonizing Pill) to relieve the abdominal distension, then use Biejia Ruangan Jiaonang (Turtle Shell Liver-Softening Capsules) to treat the hepatic fibrosis. The patient became anxious and insomniac over this illness, which further worsened the progression; the author then suggested he use a Gan Mai Dazao Tang (Licorice, Wheat and Jujube Decoction) herbal tea bag to relieve the insomnia.

After more than a month of treatment, the patient's liver function basically returned to normal and sleep returned to normal. He was then advised to continue taking Biejia Ruangan Jiaonang for three months, together with oral Chinese herbs including Chaihu (Bupleurum), Huangqin (Scutellaria), Fuling (Poria), Zexie (Alisma), Sheng Huangqi (raw Astragalus), Lianqiao (Forsythia), Wuweizi (Schisandra), Yinchen (Artemisia capillaris), Baizhu (Atractylodes), Danshen (Salvia miltiorrhiza), and Huaishanyao (Dioscorea).

In "Zhu Chenyu's Collected Experience," the author saw Professor Zhu use Xiaoyao San (Free Wanderer Powder) plus Danshen (Salvia), Sheng Shanzha (raw Crataegus), Zhi Heshouwu (processed Polygonum), and Juemingzi (Cassia obtusifolia seed)—blood-activating, lipid-lowering herbs—to treat fatty liver. In the "Zhonghua Bencao" (Chinese Materia Medica) entry for Zexie (Alisma), there is a record that Zexie can lower lipids and treat fatty liver (see "Zhonghua Bencao Selected Edition," pp. 1991-1997). Zexie lipid-lowering tablets made from Alisma extract can treat hyperlipidemia and fatty liver. These treatment approaches can all serve as references.

Cirrhosis and liver cancer are both serious, difficult-to-treat, and often incurable diseases, whereas fatty liver is preventable and reversible. People who are fond of high-fat foods easily develop fatty liver after middle age; in recent years fatty liver has even shown a trend toward younger ages. Many people nowadays are careless about their diet, which is why the incidence of cirrhosis and liver cancer is so high. Those fatty liver patients who are on the thin side mostly have metabolic problems and should seek help from professional physicians.