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Non-alcoholic Fatty Liver Disease (NAFLD) and it’s management


Are you facing any of these symptoms like nausea, fatigue, loss of appetite, jaundice, abdominal pain for a prolonged period?


If your answer is “yes” then you might be suffering from Non-alcoholic Fatty Liver Disease.

Now-a-days Fatty liver is a very common disease. The liver normally contains some amount of fat on its exterior surface that shields the organ from harmful effects of toxic substances. Fatty liver can be classified into 2 types- Alcoholic Fatty Liver Disease (due to consumption of excessive alcohol) and Non-alcoholic Fatty Liver Disease (NAFLD). However, when more than 5-10% of the liver’s wet weight comes from accumulation of lipids in the liver cells or fat deposit, in the presence of <10g of daily alcohol consumption or no alcohol consumption, then it is termed as NAFLD which leads to liver damage, ranging from simple steatosis (fat deposition in liver) to Non-alcoholic Steatohepatitis (NASH), advance fibrosis and cirrhosis of liver. [1] [2] [3]

Stages of NAFLD development : -


Classification of fatty liver according to severity is as follows –

§ Grade I - This is the initial stage of fatty liver development. Here the fat accumulation occurs only around the outside surface of the organ, which really does not interfere with the proper functioning of the liver at all. Simple form, but still requires to be managed.

§ Grade II - A middle condition that requires some medical help to prevent its progression.

§ Grade III - A severe state of the disease. It is usually at this stage that symptoms appear. [1]

Causes of fatty liver disease –


§ Genetic mutations. [4]

§ Drugs /medicines. [6]

§ Abdominal obesity, wide waste circumference (central obesity). [7]

§ Total parenteral nutrition. [8]

§ Viral hepatitis. [9]

§ Insulin resistance, diabetes type-2. [7]

§ Cardiovascular diseases like Dyslipidemia, atherosclerosis, and hypertriglyceridemia. [7]

§ Metabolic diseases (like fructose intolerance, cystic fibrosis, etc.) [10] [11]

§ Intoxication. [12]

§ Autoimmune hepatitis (the body's own immune system attacks the liver). [13]

Signs and symptoms of NAFLD [14] [15]


There are typically no symptoms at first. As time goes on, often years, peoples become experienced with following symptoms.

§ Fatigue

§ Weakness

§ Nausea

§ Weight loss

§ Abdominal discomfort

§ Poor appetite

§ Mild jaundice

§ Confusion

§ Colored patches

§ Pain in the center or right upper part of your belly.


Do you have any idea about the management if you are suffering from NAFLD?


If your answer is “No” or “Yes” but you don’t find proper way to lose weight and to maintain a healthy diet. Then let’s have a look-

NAFLD and weight loss:-


Weight loss is advisable for overweight (body mass index (BMI): 25–30 kg/m2) and obese (BMI > 30 kg/m2) patients. It should not exceed 1 kg per week. Rapid and uncontrolled weight loss can be detrimental for patients and may even worsen clinical symptoms of NAFLD. Gradual weight loss may improve the process in obese patients; rapid loss may worsen NAFLD. Specifically, walking or some form of aerobic exercise at least 30–45 minutes daily is recommended. [16] [17] [18]


What should you eat and what should you avoid in your diet?


§ You can consume whole grains (brown rice, whole wheat, rye, oats), seasonal fruits, green leafy vegetables, other vegetables, fat-trimmed meats and chicken. [19]

§ A moderate protein intake is optimum for patients with NAFLD, due to the positive impact on weight loss and insulin sensitivity. Protein intake as 25% of total calories in patients with NAFLD does not cause side effects. [20]

§ A diet rich in Monounsaturated fatty acids (MUFAs) increases the level of HDL-cholesterol and decreases the level of total cholesterol in subjects with diabetes. Include MUFAs rich foods (Olives, olive oil, sesame oil, rapeseed oil, sunflower oil, soy, peanuts, almonds etc.) in your diet. [16]

§ Polyunsaturated fatty acids (PUFAs) including docosa-hexaenoic acid (DHA) and eicosa-pentaenoic acid (EPA), positively affect the course of NAFLD. In your diet include food products (sea fish like prawn, salmon, sardine, tuna; green leafy vegetables, rapeseed oil, fish oil supplements etc.) rich in PUFAs. Use Cooking oils containing omega-3 fatty acids. [16] [19]

§ High-fructose corn syrup,[18] Soft drinks [5] [16] (Soda, Soda Pop, coca cola, Pepsi etc.), simple carbohydrates rich foods (Sugar, deep fried sweets, candies, cakes, cookies, pastries, juices, jellies, jams), refined carbohydrates (like white rice, white bread, noodles, pasta), Artificial sweeteners should be avoided. [19]



§ Intake of more saturated fatty acids (SFAs) than 10% of total energy may stimulate insulin resistance. Intake of SFAs <10% of total energy diminishes serum LDL and triglyceride levels. Recommended daily intake of SFAs (Red meat, whole-fat dairy products like cheese, butter, margarine, mayonnaise, ice-creams), coconut oil should be >7% but <10% of total energy intake. [16] [19]

§ Trans fatty acids containing foods like highly processed foods, junk foods, breakfast cereals, fast foods, fried foods should be avoided. [18] [5] [16]

Also take medications as prescribed, quit smoking, limit/ avoid alcohol, don’t take stress.


References:


Photo sources : Google

1. Fattylivercured.com/Jan.2.2013

2. Hubscher SG.; 2006; Histological assessment of nonalcoholic fatty liver disease; Histopathology; 49: 450-465

3. Kleiner DE, Brunt EM, Van natta M et al.; 2005; Design and validation of a histological scoring system for nonalcoholic fatty liver disease.; Hepatology; 41; 1313-1321

4. Petersen KF, Dufour S, Hariri A et al. (2010). "Apolipoprotein C3 Gene Variants in Nonalcoholic Fatty Liver Disease". N. Engl. J. Med. 362 (12): 1082–9.

5. Nseir, W.; Nassar, F.; Assy, N. (2010). "Soft drinks consumption and nonalcoholic fatty liver disease". World journal of gastroenterology: WJG 16 (21): 2579–2588.

6. Adams LA, Angulo P.; 2006; "Treatment of nonalcoholic fatty liver disease".; Postgrad Med J .; 82 (967).; 315–22.

7. Pacifico L, Nobili V, Anania C, et al.; 2011 Jul 14; Pediatric nonalcoholic fatty liver disease, metabolic syndrome and cardiovascular risk; World J Gastroenterol.;17(26):3082-91.

8. Hui Wang, Vladimir I. Khaoustov, Buvaneswari Krishnan, et al.; 2006 ; Total Parenteral Nutrition Induces Liver Steatosis and Apoptosis in Neonatal Piglets; The Journal of Nutrition; American Society for Nutrition.

10. Vos MB, Lavine JE.; 2013 Jun; Dietary fructose in nonalcoholic fatty liver disease.; Hepatology. 57(6):2525-31

11. O'Sullivan, BP; Freedman, SD (30 May 2009); "Cystic fibrosis.";Lancet 373 (9678): 1891–904.

12. Dr. Christine COLLAT ; hepatitis & toxic substances ; Euroliver foundation.

14. http:// WWW.Planetayurveda.com

16. Dudzik D, Knaś M, Borzym-Kluczyk M, et al.; Nonalcoholic steatohepatitis (NASH)– pathogenesis, diagnosis, treatment [Polish].; Med Sci Hepatol. 2008; 8:48–58.

17. Raszeja-Wyszomirska J, Ławniczak M, Marlicz W, et al. Nonalcoholic fatty liver disease (NAFLD) – new insight [Polish] Pol Merkuriusz Lek. 2008;24:568–71.

18. Huang MA, Greenson JK, Chao C et al. (2005). "One-year intense nutritional counseling results in histological improvement in patients with non-alcoholic steatohepatitis: a pilot study". Am. J. Gastroenterol. 100 (5): 1072–81. doi:10.1111/j.1572-0241.2005.41334.x. PMID 15842581

19. Kumar, Vinay; Fausto, Nelson; Abbas, Abul K.; Cotran, Ramzi S. ; Robbins, Stanley L.; 2005; Robbins and Cotran Pathologic Basis of Disease (7th ed.).;; Philadelphia, ISBN 0-7216-0187-1.; 1194–1195.

20. Arciero PJ, Gentile CL, Pressman R, et al. Moderate protein intake improves total and regional body composition and insulin sensitivity in overweight adults. Metabolism. 2008;57:757–65.

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