지방간 질환: 지방간 질환의 원인, 위험 및 관리 전략

### 지방간 질환에 대한 이해: 원인, 위험성 및 관리 전략
* 👩 15년 전 지방간 진단을 받은 윤현숙 씨는 규칙적인 운동과 약물 치료로 **지방간 수치가 60~90에서 30으로 감소**하는 등 상태가 호전되었습니다.
* 🩺 노력에도 불구하고 폐경 후 호르몬 변화와 관련된 복부 비만으로 인해 **내장 지방이 증가**하고 **당뇨병 및 기타 건강 문제가 발생할 위험이 높아지는 등 어려움**을 겪고 있습니다.
* 🍏 흥미롭게도 그녀는 종종 건강에 좋다고 여겨지는 과일을 많이 섭취하지만, **과당 함량이 높으면 인슐린 수치가 급상승**하여 체중 증가와 지방간을 유발할 수 있습니다.
* 📉 특히 여성의 비알코올성 지방간 질환 유병률이 **3.6배나 증가**하면서 무시해서는 안 될 건강 문제가 증가하고 있음을 시사합니다.
* 🏋 당뇨병 전단계에 있는 청년 오정 씨는 **인슐린 저항성으로 인해 과도한 포도당이 지방으로 전환**되어 지방간 질환이 악화될 수 있음을 강조합니다.
* ⚖ 건강한 음식도 과도하게 섭취하면 체중 증가의 원인이 될 수 있으므로 지방간과 당뇨병을 해결하기 위해서는 **식사량을 관리**하고 음식의 양을 파악하는 것이 중요합니다.
* 📊 신현필 교수가 실천하는 **매일 체중 모니터링**은 식이 효과에 대한 귀중한 통찰력을 제공하고 건강한 체중 감량을 유지하는 데 도움이 될 수 있습니다.
* 🚨 궁극적으로 지방간은 잠재적인 건강 합병증의 경고 신호로 작용하여 **더 심각한 간 질환으로의 진행을 예방하기 위한 식단, 운동 및 정기적인 건강 검진의 중요성**을 강조합니다.

윤현숙 씨의 지방간은 약물치료와 운동, 식습관 개선으로 호전되고 있어 전인적인 건강 관리의 중요성을 강조하고 있습니다.

Yoon Hyun-sook, in her sixties, learned about her fatty liver fifteen years ago. Hello, Hyun-sook. How have you been? Yes, I have diabetes and I regularly visit the doctor to manage my fatty liver. That's why I’m taking medication. As you can see, there is some fat in the liver. The liver shows up as white on the scan, indicating that there is fatty liver present. Previously, her fatty liver was more severe, reaching up to 60 or 90, but last time it was 40, and now it is down to 30. Her fatty liver levels are gradually improving. As she exercises, her liver enzyme levels are decreasing. The yellow highlighted area indicates her hyperlipidemia. The LDL cholesterol level should be below 100, and it is currently at 78, which is manageable with the medication she is taking. The blue indicates visceral fat, while the green represents fat between the organs. However, this green fat is more than the visceral fat.

If the ratio is above 0.4, it's considered high. However, if it's 0.6, then I think, in fact, if we look at the waist circumference, the average waist circumference for women in South Korea is about 85 cm. This means that, even with the same waist circumference, there tends to be more fat distributed around the organs, which makes me think this could lead to diabetes, high blood pressure, and hyperlipidemia. Just looking at the waist circumference, it clearly indicates abdominal obesity. Gaining weight means that there is an excess of fat in the body, which refers to body fat. Body fat consists of subcutaneous fat and visceral fat in the abdomen. Abdominal fat, in particular, refers to an excessive amount of visceral fat. The food we consume is converted into glucose, which is used as an energy source. Any leftover glucose that is not used as energy gets converted into fat and stored. Initially, fat accumulates beneath the skin, in the subcutaneous layer, and any remaining fat then...

Visceral fat accumulates between the organs, causing inflammation. At this time, the remaining fat is stored in the liver, creating fatty liver disease. I originally didn't eat much rice. I don't really understand why fatty liver developed. Their father doesn't drink alcohol, doesn't eat snacks, and doesn't smoke. He wonders why so many health issues have arisen in his body. Yoon Hyun-sook doesn't enjoy eating meat and doesn't overeat either. What could be the reason for her fatty liver and the onset of abdominal obesity? When she goes to the market, she always stops by the fruit shop. Yoon Hyun-sook doesn't just choose one type of fruit. Even if she doesn't eat rice well, she makes sure to eat plenty of fruit. There are times when she feels full from fruit alone. Even when getting up at night to go to the bathroom, she grabs a piece of fruit from the table before heading back.

It seems that fruits, which are said to be good for the body, might actually be causing fatty liver and abdominal obesity. People often say they hardly eat rice, but they actually consume a little rice and mostly eat concentrated foods like rice cakes, bread, or other carbohydrates, along with a lot of fruits. Fruits high in fructose can suddenly raise insulin levels, and to quickly manage the spike in sugar, a large amount of insulin is released. After insulin is released, the sugar just consumed is hydrated, but as blood sugar drops again, they tend to eat something sweet. This leads to more insulin being released, and as they experience cravings, they eat more sweets. Thus, a vicious cycle begins, leading to obesity. Despite trying, weight loss is not easy, and the fatty liver issue is not being resolved. Yoon Hyun-sook's weight is not particularly high, yet...

Why has it come to the point of abdominal obesity? In our country, for those over 50, menopause leads to a deficiency in female hormones. When estrogen, the female hormone, becomes insufficient, cholesterol levels in the body rise, blood sugar levels increase, and significant obesity occurs. Visceral fat accumulates more as well, making middle-aged women much more vulnerable to obesity. Over the past five years, the number of patients with alcoholic fatty liver disease has shown a gradual decline. However, in contrast, the number of patients with non-alcoholic fatty liver disease has steadily increased each year. 

In particular, the number of female patients with fatty liver who do not consume alcohol has increased by a staggering 3.6 times. Women cannot be complacent about fatty liver disease. Please come to the office. A young man in his 20s, Mr. Oh Jung, is also significantly overweight. Since experiencing a traffic accident four years ago, he has been avoiding exercise due to discomfort in his body.

After that, my weight increased rapidly. As my weight gained, I had blood tests every 30 minutes to monitor my condition. Fortunately, I haven't developed diabetes yet, but I was already at the pre-diabetic stage. When I drank a sugar solution and had my blood drawn every 30 minutes, the most important factor was that my blood sugar should not exceed 140 after two hours. However, it was at 180, which indicates pre-diabetes. So, I am not diabetic yet, but I am at a crucial point where I could progress to diabetes. My insulin secretion is quite active, but there is insulin resistance in my body. Therefore, my insulin resistance markers are very high. The food we eat is converted into glucose through digestion. At this time, the hormone insulin is released. Our cells use blood sugar as an energy source. Insulin binds to receptors to help glucose enter the cells.

It creates energy sources by pushing in. At the same time, it regulates the blood sugar in the body. However, when insulin fails to function properly and a state of insulin resistance occurs, glucose cannot enter the cells, resulting in an overflow of glucose in the blood and a state of hyperglycemia. When there is an excess of blood sugar in our body, glucose that cannot be converted into energy accumulates as fat, ultimately leading to fatty liver disease. Additionally, fat accumulates in the blood vessels, causing inflammation, and oxidative stress in the blood vessels increases, which can lead to complications such as stroke or heart disease. Therefore, if there is fat in the liver, the liver is responsible for producing sugar or metabolizing it in the body through insulin. The liver is the most important organ, and if it is filled with fat, glucose metabolism will be disrupted. Furthermore, having fatty liver itself indicates that the hormone insulin in my body is not functioning properly. So, this is a sign.

Be careful, as fatty liver can lead to diabetes. The risk of developing diabetes in patients with fatty liver is 1.8 times higher. Ms. Oh Jung-sun is receiving education and is making efforts to prevent the progression to diabetes. One serving is 210 grams and 300 calories. For male diabetes patients, they can eat one serving, while women can have three-quarters of that. So, a half serving is what we typically consume. 

Now, let's look at this: one circle, two circles—what does that represent? One ping pong ball, two ping pong balls. Unfortunately, the amount of meat is one piece, two pieces, which corresponds to one ping pong ball, two ping pong balls. This is meat, specifically red meat, followed by fish—four servings of fish. Then, we have one plate, two plates of vegetables. Additionally, think of the amount of peanuts as the size of your thumb. 

To address fatty liver and diabetes, the first step is to reduce your meals. You can eat everything, but...

Understanding the concept of quantity is actually very important, which is why we make a lot of efforts to educate about it. It's okay to eat, but it’s important to eat in moderation. We continuously teach that it’s not about eating a lot, but rather managing the amount we consume. By controlling the quantity of food we eat, we can lose weight without starving ourselves. The key here is to eat sufficiently and evenly without exceeding the set limits. 

Additionally, some people tend to avoid protein intake out of fear of gaining weight, but it's crucial to include it in every meal to strengthen muscles. We also need to pay attention to carbohydrate intake. But why do we accumulate fat in our bodies even when we consume carbohydrates? Our bodies break down the carbohydrates we eat into sugars, which are then used as energy sources. Carbohydrates are made up of sugars, and depending on the structure of these sugars, they can be classified as monosaccharides, polysaccharides, or complex carbohydrates.

당이 에너지로 쓰이기 위해서는 탄수화물을 섭취한 후 소화 효소에 의해 당이 분해됩니다. 먼저, 빵에 있는 탄수화물의 경우, 결합되어 있는 당들이 소화 기관에서 나오는 효소에 의해 쉽게 분해되고 빠르게 화됩니다. 때문에 혈액에 많은 포도당을 내보내 혈당 수치를 올립니다. 탄산음료 또한 이와 비슷하게 작용합니다. 그러나 섬유소가 많은 음식은 조금 다릅니다. 탄수화물의 결합 구조가 소화 기관의 효소에 의해 쉽게 분해되지 않기 때문에 포도당이 혈액으로 나가는 것을 늦춰 당을 쉽게 올리지 않습니다. 이런 이유로 빵보다는 소화가 잘 되는 밥과 통곡물이 살을 덜 찌게 합니다. 지방간이 생기는데, 그게 꼭 지방이 많은 음식만 먹어서 생기는 것은 아닙니다. 탄수화물이 굉장히 많은 음식을 먹어도 지방간이 올 수 있습니다. 또 야채나 과일을 드실 때도 그냥...

It's better to chew them. Some people blend them into juice, but if we just chew them, the sugar level might rise by about 100. However, if you blend it into juice, the sugar level increases much more. So, when consuming vegetables or fruits, it's better to chew them and take them in a fiber-rich state rather than in juice form. 

It's easy to think that fatty liver is not a disease, but there comes a moment when it becomes dangerous. Today, Lee Seong-jin came back to the hospital after two weeks. His ascites have increased due to the progression of cirrhosis and complications. After we remove the ascites, we'll see if his shortness of breath improves. He has been experiencing shortness of breath and a bloated stomach, and his abdomen has been getting larger. At first, it can be managed well, but now...

You can't use it sufficiently; you can't use it, and as liver cirrhosis progresses, the best option ultimately is a liver transplant. However, the process of transplantation takes a long time. In the case of simple fatty liver, it is possible to return to a healthy liver, but it is difficult to reverse cirrhosis. Lee Seong-jin, who started experiencing ascites a year ago, is finding that the intervals between his hospital visits to drain the fluid are becoming shorter. The liver, hardened by cirrhosis, does not allow for good blood circulation. As its synthesis and detoxification functions decline, various complications arise. If the liver cannot produce enough albumin, fluid accumulates in the abdominal cavity, leading to ascites. When ascites builds up, it must be drained artificially. Additionally, as the liver hardens, the intrahepatic blood vessels become compressed under pressure, making it difficult for blood to flow into the liver.

The esophageal varices occur when blood vessels around the stomach and esophagus swell and burst. When these swollen vessels rupture, it can result in vomiting blood. Additionally, as liver function deteriorates, toxins such as ammonia cannot be properly detoxified, allowing them to flow into the bloodstream and reach the brain. This condition is referred to as hepatic encephalopathy, leading to unstable behavior and consciousness. 

As the liver becomes hardened, the blood vessels entering it also experience increased pressure, which can cause the surrounding vessels to expand. Furthermore, the hardened liver is less efficient in performing its original functions, such as metabolizing substances, regulating glucose, secreting bile, and producing proteins. Consequently, liver function declines, and this can also impact adjacent organs.

Having fatty liver generally indicates that insulin function is not operating smoothly. Additionally, it is often accompanied by conditions such as diabetes, high blood pressure, and high cholesterol. Due to the excess visceral fat, a significant amount of inflammatory substances are released from the abdominal fat, which can lead to increased cholesterol in the blood vessels, resulting in conditions like heart attacks, strokes, and atherosclerosis. This means that it can worsen vascular health. 

Who tends to accumulate more visceral fat, which is a cause of fatty liver? Here we have two individuals: Oh Jung-seon, a 20-year-old who is overweight, and Choi Tae-jun, a 70-year-old who is thin. We measured their visceral fat and subcutaneous fat levels. Oh Jung-seon has 24% visceral fat, while Choi Tae-jun has 90%. Why does Choi Tae-jun, who is managing his weight better, have more visceral fat than the overweight young person? The younger individual still has some level of...

Insulin functions smoothly, and because of that, in the early stages, you may have significantly more subcutaneous fat. Even if the waist circumference remains the same, as you age, visceral fat tends to increase. The reason for the rise in visceral fat compared to subcutaneous fat is that muscle mass decreases with age. As a result, the energy from the food you consume is not stored in muscles but accumulates as fat. Additionally, with reduced physical activity, the insufficient muscle cannot compensate, leading to the accumulation of visceral fat. This is why, as we age, it is essential to exercise and take care of our bodies. When we exercise diligently, we can utilize more glucose in the bloodstream with the same amount of insulin. This helps prevent the accumulation of fat in the body. As the amount of muscle increases, more glucose in the blood is used, which lowers blood sugar levels. Furthermore, the more muscle you have, the more calories you burn.

As consumption increases, it helps to burn off fat effectively. This is not only beneficial for weight control but also significantly aids in improving fatty liver. Therefore, it is recommended to limit weight loss to about 1 kg per week and to approach it gradually. In cases of severe fatty liver, a reduction of about 10% is advised initially. Typically, if we consider a common weight of around 70 kg, it is suggested to aim for a weight loss of about 2 to 3 kg in the first month. However, if there is a substantial weight loss, it is necessary to consult a doctor. If we take 70 kg as a reference, a weight loss of around 7 kg in the first three months would be considered a very appropriate rate of loss. Professor Shin Hyun-pil, who has been consistently maintaining his weight loss, emphasizes that aside from exercise and dietary therapy, there is one more special effort in his diet. Since March of last year, he has been tracking his weight without missing a single day.

I am recording this. Why do I measure my weight every day? The habit of measuring and recording my weight daily allows me to understand whether my diet from the previous day was effective or not. By looking at my weight over the week, I can tell if I gained weight because of what I ate, or if my weight didn’t drop as expected. This way, I can identify what might be wrong with my food choices. So, don’t think too grandly about it; by reducing my meal portions and adjusting my diet while measuring my weight daily, I can accurately know if I am heading in the right direction. Fatty liver disease often associates with bad friends like diabetes, high blood pressure, and high cholesterol, threatening our health. It’s a warning sign: will it lead to cirrhosis, or will it stop here? Right now, fatty liver is sending a signal. When the yellow light turns on...

In addition to fatty liver, it is important to check for other potential issues. People with fatty liver often have other conditions such as high blood pressure, cholesterol, and blood sugar levels. It can be a good opportunity to confirm whether these factors are being managed. Therefore, fatty liver can be seen as a yellow signal. It would be great if there were a medication that could completely eliminate the fat in the liver with just one pill, but such a medication does not exist. Ultimately, the way to eliminate fatty liver is through diet and exercise. It's essential to engage in regular exercise and work on losing weight, as managing obesity and returning to a normal weight are the most important treatments.

“밥은 거의 안 먹습니다” 소식, 금주해도 지방간이 생긴다? │명의│#EBS건강

【EBS 명의】, 【다큐프라임】, 【귀하신 몸】 등 EBS의 다양한 고품격 프로그램으로 최신 의학정보 및 건강정보를 전달하겠습니다.
당신이 꼭 알아야 하는 의학 정보 콘텐츠!



EBS 건강

60대 윤현숙 씨는 15년 동안 지방간과 당뇨병을 관리해 왔으며 간 지방 수치는 점차 개선되고 있습니다.

건강한 생활 습관과 과일이 풍부한 식단에도 불구하고 복부 비만과 내장 지방 과다로 인해 다양한 건강 문제가 발생할 수 있습니다.

LDL 콜레스테롤 수치는 관리 가능한 수준이며, 운동과 약물 치료를 통해 간 효소 수치를 낮추는 데 집중하고 있습니다.

과일과 호르몬 변화가 비만에 미치는 영향

과당 함량이 높은 과일은 인슐린 급상승과 식탐을 유발하여 비만을 유발하는 악순환을 일으킬 수 있습니다.

중년 여성, 특히 50세 이상의 여성은 에스트로겐과 같은 여성 호르몬 결핍으로 인해 복부 비만에 더 취약합니다.

비알코올성 지방간 질환 환자, 특히 여성의 수가 꾸준히 증가하고 있어 이에 대한 인식과 개입의 필요성이 강조되고 있습니다.

인슐린 저항성과 지방간이 건강에 미치는 영향

인슐린 저항성은 고혈당으로 이어져 포도당이 지방으로 축적되어 지방간 질환을 일으킬 수 있습니다.

지방간은 포도당 대사를 방해하고 인슐린 기능 장애의 징후로 당뇨병 발병 위험을 높입니다.

식사량을 관리하고 매 끼니 단백질을 섭취하는 것은 지방간과 당뇨병을 예방하기 위한 핵심 전략입니다.

탄수화물이 혈당과 지방간에 미치는 영향

탄수화물은 소화 효소에 의해 당으로 분해되며, 빵이나 탄산음료와 같은 속효성 식품은 혈당 수치를 빠르게 높입니다.

반면 섬유질이 많은 음식은 포도당이 혈류로 방출되는 속도를 늦춥니다.

지방간은 탄수화물 과다 섭취로 인해 발생할 수 있으며, 단순 지방간은 회복할 수 있지만 간경변증은 치료가 더 어려워 간 이식이 필요한 경우가 많습니다.

간 기능 장애와 내장 지방의 영향

식도 정맥류는 위와 식도 주변의 혈관이 부풀어 터지면서 피를 토하고 간성 뇌증을 유발할 수 있습니다.

간이 딱딱해지면 혈관에 가해지는 압력이 증가하여 혈관이 확장되고 필수 기능을 수행하는 능력이 저하됩니다.

나이가 들면서 더욱 두드러지는 내장 지방 축적은 인슐린 기능 장애와 관련이 있으며 콜레스테롤 증가 및 혈관 건강 문제로 이어질 수 있으므로 체중 관리와 지방 축적을 예방하기 위해서는 운동이 중요합니다.

지방간 관리를 위한 효과적인 전략

섭취량을 늘리면 지방을 태우고 지방간을 개선하는 데 도움이 될 수 있으며, 일주일에 1kg의 체중 감량을 권장합니다.

매일 체중을 추적하면 식단과 운동의 효과를 파악할 수 있으며, 지방간은 고혈압이나 콜레스테롤과 같은 다른 건강 문제를 나타내는 경우가 많습니다.

궁극적으로 지방간을 없애는 열쇠는 식단, 운동, 비만 관리를 통한 것입니다.