THE liver is the largest internal organ of the human body. The major function of the liver is to remove toxic materials and waste materials out of our bodies.
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As blood is filtered through it, the liver removes all bacteria, dead cells, and waste materials, as well as toxic materials that we ingest, breathe in or absorb through the skin. Other than purifying the blood, the liver also synthesises bile juice for digestion of fat. It stores energy, vitamins and minerals. It synthesises blood clotting factors and regulates blood sugar levels and cholesterol level.
It goes without saying that it is very important to maintain healthy liver performance.
One of the most common problems that can affect the liver is fatty liver, and it is estimated to affect approximately 17% of Malaysians.
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What is fatty liver?
A healthy liver usually consists of 2% to 5% fat. If fat in the liver accumulates over 5% of liver weight, this is called fatty liver, or in medical terms, “steatosis”. When fat exceeds 10% of liver weight, the fat cells can damage liver cells.
Fatty liver can develop in three different stages:
1. Simple fatty liver disease (steatosis) The liver progressively accumulates fat and damage to liver cells begins. This is called non-alcoholic fatty liver disease (NAFLD). Most show no symptoms or very vague symptoms. At this stage, there is commonly no enlargement of the liver.
2. NASH (Non-alcoholic steatohepatitis) Excessive fat accumulation causes inflammation of the liver cells and eventually damages liver cells. Dead liver cells form scar tissues.
3. Cirrhosis (hardening of the liver) Excessive scarring of liver tissues causes hardening of the liver. The liver fails to perform properly. Cirrhosis can be life-threatening.
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There are several factors that increase the risk of fatty liver:
1. Type 2 diabetes Statistics show that 88% of type 2 diabetes patients develop NAFLD.
2. Overweight A person is considered overweight when his Body Mass Index (BMI) is between 23 and 27.4. Fat in the organ does increase in proportion with body fat percentage. Approximately 37.4% of NAFLD patients are found to be overweight.
3. Obese Obesity occurs when a person’s BMI exceeds 27.5. According to statistics, NAFLD is found in 80% of obese patients.
4. High cholesterol About 63% of NAFLD patients are found to have high cholesterol.
5. High triglycerides About 55.4% of NAFLD patients are found to have high triglycerides.
6. Malnutrition Nutrition deficiencies caused by poor diet and rapid weight loss can increase triglyceride levels in the blood.
7. Alcohol drinkers Consuming more than 60g of alcohol per day is considered as excessive alcohol intake. Statistics indicate that 90% to 100% of heavy alcoholic drinkers develop fatty liver disease. Fatty liver disease caused by abusive intake of alcohol is called alcoholic fatty liver diseaase (AFLD).
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The potential health problems that are posed by NAFLD should not be taken lightly, especially for those who suffer from metabol- ic problems as mentioned above.
There are many tests available to assess the condition of the liver. The liver function test measures enzyme level increase caused by fatty liver. Imaging modalities such as ultrasound, MRI, and CT scan are non-invasive options. Biopsy can conclusively diagnose NAFLD by collecting tissue sample from the liver and observing the tissue under a microscope.
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Maintaining a healthy liver
Diet and lifestyle are the most fundamental ways of controlling or preventing fatty liver disease. Here are some tips for maintaining a healthy liver and preventing fatty liver disease:
1. Consume food with low glycaemic index (GI) and avoid food with high GI.
Food with GI of more than 55 are considered high GI food while food with GI lower than 55 are low GI food. Examples of high GI food are candies, white bread, potatoes, white sugar, white rice, etc. Examples of low GI food are apples, wholemeal bread, oats, etc.
2. Low fat diet Fat should not exceed 20% of our total daily calorie intake. A high fat diet will increase triglyceride levels in the blood and therefore increases the risk of fatty liver.
3. High fibre diet Increase intake of fresh fruits and vegetables, oats and grains, and reduce refined and highly processed food. A diet high in fibre can help reduce blood sugar, cholesterol, and triglyceride levels and therefore reduce risk of fatty liver.
4. Regular exercise Maintain moderate to high intensity exercise for at least 30 minutes per session, at least three times a week. Exercise is the most effective way to bring down blood sugar and maintain a healthy body weight.
5. Healthy weight loss If you are overweight or obese, maintain a low fat diet and cut down calorie intake by 500kcal to 1000kcal daily. Do not starve yourself to lose weight as this will cause malnutrition and actually increases triglyceride level. A healthy weight loss aim is to reduce approximately 1-1.5kg per week.
6. Avoid alcohol This is especially for those who have alcohol-induced fatty liver disease. Abstain from alcohol altogether.
Polyunsaturated fatty acids, also known as essential phospholipids (EPL), are vital nutrients to support healthy liver cells. EPL is one of the major constituents of liver cell membranes. The cell membrane is the protective layer of the cell. Sufficiency of EPL in cell membranes determines the optimum function of the cell.
When liver cells are inflamed, EPL is lost and destroyed, causing loss of cell structure, loss of cell function, and eventually death of cell.
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In modern science, EPL oral administration is found to have protective, curative, and regenerative effects on the membranes of liver cells. References:
1. Amarapurkar, D.N. et al. Journal of Gastroenterology and Hepatology 2007
2. Falck-Ytter Y, Thiruppathi S, Dasarathy S, Rogers N, McCollough AJ. Hepatology 2006
3. emedicine: Alcoholic Fatty Liver – article by Ismail, M.K. and Riely, C. http://emedicine.medscape.com/article/170409-overview. Accessed Sept 2009.
4. Malik, A. et al Journal of Digestive Diseases 2007
Fennie Yap is a nutritionist. This article is courtesy of sanofi-aventis. The views expressed are those of the writer and readers are advised to always consult expert advice before undertaking any changes to their lifestyles.
