Dr. Yang Naibin communicating with a patient. Stock image
“I have been vegetarian for the past six months, mostly eating boiled vegetables. How could I be diagnosed with moderate to severe fatty liver? This is not logical!” Recently, Ms. Liu, a 29-year-old from Ningbo, was puzzled.
In people’s minds, fatty liver is often associated with obesity. Dr. Yang Naibin from the Infectious Disease Department of Ningbo University First Hospital stated that this is not entirely true. Based on his outpatient experience, 20%-30% of fatty liver patients are not obese; they have normal or even lean body weights.
Going Vegetarian for Six Months, Fatty Liver Worsens
Six months ago, Ms. Liu was diagnosed with mild fatty liver during a health checkup. This left her feeling discouraged. At that time, she was 160 cm tall, weighed 116 pounds, had an overall normal body size, and had a “swimming ring” around her abdomen.
After the fatty liver diagnosis, Ms. Liu decided to shed the label of having fatty liver within six months. Her thinking was that overeating non-vegetarian food leads to fatty liver, so she opted for a vegetarian diet. She began a six-month regimen of eating mostly “boiled vegetables” with minimal staple foods, giving up meat and refined carbohydrates. Her meals mainly consisted of boiled leafy greens with steamed mixed grains.
Confident during her reevaluation at Ningbo University First Hospital, Ms. Liu felt positive. Over the past six months, she had lost around 10 pounds, her waistline had noticeably flattened, and she believed that the fatty liver would no longer be mentioned in the medical report.
To her surprise, the ultrasound examination revealed her fatty liver had progressed to moderate to severe. Despite eating vegetarian for six months, the severity of her fatty liver had increased!
“Rapid Weight Loss” is Unscientific
Dr. Yang Naibin explained that for those with fatty liver due to obesity, healthy and scientific weight loss is beneficial for downgrading and reversing fatty liver. However, unhealthy and unscientific weight loss methods, especially excessive dieting with severe protein deficiency, may worsen fatty liver.
He emphasized that the main principles of scientific weight loss diets include: ensuring protein intake, increasing leafy green vegetable consumption, reducing greasy foods and refined carbohydrates intake, abstaining from alcohol and soft drinks. Ms. Liu’s “rapid weight loss” was not scientifically sound, and the most unscientific aspect was that she had hardly consumed any protein and fats for six months.
Why would such an eating habit lead to worsening fatty liver? Dr. Yang Naibin analyzed several reasons.
Firstly, the liver requires protein for the breakdown and metabolism of fat. In layman’s terms, protein acts as a vehicle that transports fats out of the liver. If protein intake is severely inadequate, fat within the liver cannot be transported out, leading to fat accumulation in the liver and worsening fatty liver. Protein is also an essential source for increasing skeletal muscle mass, which is vital in combating insulin resistance and alleviating fatty liver. Thus, the aggravation of fatty liver due to a lack of protein in the diet is not surprising.
Secondly, prolonged consumption of boiled vegetables deprives the body of essential energy, causing fats to rapidly break down and produce a large amount of fatty acids that enter the liver and stay for an extended period, which can trigger fatty liver.
20%-30% of Fatty Liver Patients are Not Obese
During outpatient consultations, many patients inquire while holding their medical reports: “Doctor, I’m not obese, why do I have fatty liver?”
Dr. Yang Naibin explained: Many assume that fatty liver is primarily associated with obesity. This perception has some misunderstandings. Based on outpatient observations, 20%-30% of fatty liver patients have normal body weights, or are even lean. It can be said that having fatty liver without being obese is not rare but rather quite common.
He elaborated that while obesity is a significant factor in fatty liver, it is not the sole cause. Common reasons for lean individuals having fatty liver include the following types.
One type is “pseudo-lean individuals.” Despite possibly having a lower body weight and BMI, with limbs and the trunk even appearing lean, they may have a significant accumulation of fat around the abdomen. This central obesity population has a high probability of developing fatty liver.
Another type includes patients with muscle depletion, often seen in the elderly and postmenopausal women.
Diabetic patients represent another group. Diabetes and fatty liver often have a mutual causative relationship, where some diabetic patients with slim bodies may also have fatty liver.
There is also a group with malnutrition-related fatty liver. This commonly occurs in individuals who have been on a long-term vegetarian diet with severe protein deficiency, similar to Ms. Liu’s situation.
Additionally, certain medications, Hepatitis C Virus genotype 3, alcohol, and other factors can also act as triggers for fatty liver under specific circumstances.
Dr. Yang Naibin reminded that it is not scientifically accurate to judge the presence of fatty liver solely based on body size and weight. Physicians will comprehensively evaluate through liver function and biochemical tests, liver ultrasound imaging, among others, to make a holistic assessment. (Ningbo Evening News Reporter Wang Ying Communication Officer Pang Yun)
