Fatty Liver (Steatosis Hepatis): Prevention

To prevent nonalcoholic fatty liver, attention must be paid to reducing individual risk factors. Behavioral risk factors (= metabolic risk factors).

  • Diet
    • Excessive caloric intake, especially with a high-carbohydrate diet
      • Increased fructose intake is considered an independent risk factor for nonalcoholic fatty liver disease (NAFLD). Also, excessive fructose intake may promote hepatic inflammation (chronic inflammation in the liver) due to fructose-induced ATP depletion (depletion of energy stores).
    • Too much animal protein – Research shows that, especially in older people who are overweight, a diet high in animal protein is associated with an increased risk of nonalcoholic fatty liver.
    • Rapid weight loss
    • Fatty liver developing during starvation is due to a lack of protein (protein deficiency) on a high-carbohydrate diet (kwashiorkor)
    • Total parenteral nutrition (TPE) – infusion program in which the patient is supplied with all necessary macro- and micronutrients through the vascular system (para enteral = next to the intestine); thereby completely bypassing the digestive tract.
  • Consumption of stimulants
    • Alcohol (woman: ≥ 10 g/day; man: ≥ 20 g/day); to distinguish nonalcoholic fatty liver disease (NAFLD) from alcoholic fatty liver (ALD) or mixed forms, a daily alcohol limit of 10 g in women and 20 g in men can be adopted. At higher daily amounts of alcohol can not be safely excluded alcoholic fatty liver
    • Tobacco (smoking)
  • Physical activity
    • Physical inactivity
    • > 10 hours sitting/day and regardless of how much exercise is done (possibly due tohigher caloric intake).
  • Overweight (BMI ≥ 25; obesity).
  • Android body fat distribution, that is, abdominal/visceral, truncal, central body fat (apple type) – high waist circumference or waist-to-hip ratio (THQ; waist-to-hip ratio (WHR)) is present When measuring waist circumference according to the International Diabetes Federation (IDF, 2005) guideline, the following standard values apply:
    • Men < 94 cm
    • Women < 80 cm

    The German Obesity Society published somewhat more moderate figures for waist circumference in 2006: < 102 cm for men and < 88 cm for women.

Prevention factors (protective factors)

  • Genetic load
    • Genes/SNPs (single nucleotide polymorphism; English : single nucleotide polymorphism):
      • Gene: HSD17B13
        • SNP: rs72613567 in gene HSD17B13
          • Allele constellation: AA (53% lower risk for alcohol-related liver disease; 30% for nonalcoholic steatohepatitis (NASH)).
          • Allele constellation: AT (42% lower risk for alcohol-related liver disease; 17% for nonalcoholic steatohepatitis (NASH)).
  • Coffee consumption – 2-3 cups of coffee appear to reduce the risk of non-alcoholic fatty liverConsumption of coffee may be recommended due to hepato- and cardioprotective effects (due topolyphenols with anti-oxidant effects). (strong consensus) (open recommendation).
  • Limit consumption of free sugars such as glucose (dextrose; monosaccharide/simple sugar), fructose (fruit sugar; monosaccharide/simple sugar), sucrose (household sugar; disaccharide/disaccharide) – An American study showed that adolescents who had non-alcoholic fatty liver disease (NAFLD) regressed significantly within a few weeks on a low-sugar diet. The diet consisted primarily of avoiding refined sugar and sweet beverages. The values of liver enzymes – alanine aminotransferase, aspartate aminotransferase, gamma-glutamyltransferase – improved.