Non-alcoholic fatty liver disease and the influence of diet on the non-alcoholic fatty liver disease so the different types of diets and how they may actually lead to improvements or reduce the risk of actually getting the non-alcoholic fatty liver disease but first we'll first talk about what non-alcoholic fatty liver disease is it is a liver disease.
That is not caused by ethanol or alcohol use and it's characterized by fatty infiltration of the liver so that is non-alcoholic fatty liver disease and its etiology is mostly related to insulin resistance so as insulin resistance becomes worse we see more and more fatty infiltration of the liver leading to inflammation of the liver and eventual liver disease.
So individuals who have the non-alcoholic fatty liver disease can either be asymptomatic or they can have vague symptoms and these symptoms can include malaise and fatigue so they can be very tired and they can have pain in the right upper quadrant it's usually a dull discomfort so the right upper quadrant would be on the right side so we're looking at a patient directly on but this is the right side here and it's in upper area so right upper quadrant and it's a dull discomfort so they may have something
like that now the typical treatment for non-alcoholic fatty liver disease is weight loss and it's usually targeted for 0.5 to 1 kilogram per day with a goal of losing at least 10 percent of body weight so that is the usual treatment for non-alcoholic fatty liver disease.
It’s also important to avoid ethanol use as well so that was a quick rundown of non-alcoholic fatty liver disease.
About diet specifically and its role in non-alcoholic fatty liver disease so there's actually been evidence demonstrating that certain diets and supplements lead to improvement of we're going to talk about those in the next few slides but before we get into some of the diets that improve and let's talk about some of the dietary selections that are associated with actually getting non-alcoholic fatty liver disease.
So these come from the paper entitled higher adherence to plant-based diets are associated with a lower likelihood of
fatty liver so we're going to talk about this paper a little later on but there are a few key points noted in this paper
that I want to talk about so there's actually been some reports indicating that patients with and consume diets
consisting of the following so these dietary selections are associated with actually getting the non-alcoholic fatty liver disease or having a high risk of getting it and these include increased saturated fatty acids and it's oftentimes from fatty meats and dairy products certain dairy
products so high-fat content dairy products are more likely so an increased consumption of saturated fatty acids is associated with non-alcoholic fatty liver disease
and then there's also an association with increased consumption of carbohydrates so these are the types of dietary selections that are associated with an increased risk of having and so now that we know that let's move on and look at coffee consumption so in the review entitled coffee and non-alcoholic fatty liver disease brewing evidence for hepatoprotection it's been shown that coffee consumption is associated with a reduced risk of
cirrhosis so the end stage of liver disease and with regards to non-alcoholic fatty liver disease several studies have shown that coffee consumption mediates the following coffee has been shown to mildly reduce the incidence of non-alcoholic fatty liver disease increased coughing consumption is associated with reduced non-alcoholic fatty liver disease grade and increased coffee consumption is also associated with a reduced stage of fibrosis from so all of these are very important it reduces the incidence but also if a patient does already haveit may protect from the progression of non-alcoholic fatty liver disease and these beneficial outcomes seem to occur in a dose-dependent manner so it's recommended that at least three cups of coffee per day is consumed to actually improve outcomes with regards to non-alcoholic fatty liver disease so the next dietary selection or supplement we're going to talk about is vitamin E and the following results come from this article entitled effect of mediterranean diet and antioxidant formulation in non alcoholic fatty liver disease a randomized study so this is vitamin E this is alpha tocopherol there are other vitamin but this is the one we're talking about here and it's important to recognize that in non-alcoholic fatty liver disease there is oxidative stress and inflammation so antioxidants are very important antioxidants scavenge free radicals including reactive oxygen species or ros and the reason i mention this is because vitamin E is an antioxidant and it's been demonstrated have the following
beneficial effects in non-alcoholic fatty liver disease including reduced hepatic oxidative stress damage reduced hepatic inflammation so hepatic means liver so reduce the liver inflammation reduced hepatic fibrosis
and these can also be found when studies combine vitamin E with vitamin c so very important here vitamin e supplementation because vitamin E is an antioxidant and
we have oxidative stress and inflammation.
In non-alcoholic fatty liver disease, vitamin e supplementation has been shown to reduce hepatic or liver oxidative stress damage reduce hepatic inflammation and reduce hepatic fibrosis so all very important so what are some of the dietary sources of vitamin E where can you actually get vitamin E in your diet so some dietary
sources include nuts and seeds vegetable oils and some green leafy vegetables so these are the sources of vitamin E the typical quoted vitamin e supplementation in non-alcoholic fatty liver disease is 800 units and it's used particularly when there's actually hepatic inflammation so
when the liver has been inflamed or is currently inflamed vitamin E can be used at that time so 800 units of vitamin E the next vitamin we're going to talk about with regards to non-alcoholic fatty liver disease is vitamin E.
So the information presented here is from the paper entitled vitamin D supplementation and non-alcoholic fatty liver disease present and future so this is vitamin d calcitriol now there has been an association between vitamin D deficiency and a higher incidence of non-alcoholic fatty liver disease so as vitamin D levels go down the incidence of non-alcoholic fatty liver disease goes up and particularly the degree of steatosis or the degree of fatty infiltration of the liver however evidence has been controversial some findings don't support this and some do now one randomized control trial in children demonstrated improvement in the non-alcoholic fatty liver disease activity score with vitamin d 800 international units in combination with docosahexaenoic acid DHA 500 milligrams per day so there may be some evidence to support vitamin d supplementation in reducing the risk of non-alcoholic fatty liver disease so what are some of the
sources of vitamin D some of them include meat and fish
dairy products like milk that have been fortified with vitamin D and also vitamin D supplementation the next type of diet we're going to talk about is plant-based diets so this comes from the article entitled higher adherence to plant-based diets are associated with a lower likelihood of
fatty liver so many vegetarian diets are abundant in
antioxidants and abundant in anti-inflammatory compounds known as phytochemicals we've talked about the importance of antioxidants in reducing the oxidative stress damage in non-alcoholic fatty liver disease when
we talked about vitamin E so this was a cross-sectional study looking at three different versions of plant-based diets and they rank these diets from healthy to non-healthy according to the dietary selection of each so in the healthy category fruits vegetables whole grains legumes and vegetable oils were in the healthy group and then the less healthy or unhealthy it was fruit juices and other sweetened beverages potatoes and refined grains and what they found was that higher adherence to more healthy plant-based diets is associated with a lower incidence of non-alcoholic fatty liver disease and lower measurements of liver inflammation so the healthier plant-based options fruits vegetables whole grains legumes vegetable oils over the other types of less healthy alternatives fruit juices
potatoes and those types of dietary selections the next type of diet we're going to talk about is the Mediterranean diet so this comes from the article entitled Mediterranean diet and multi-ingredient based interventions for the management of non-alcoholic fatty liver disease so the Mediterranean diet contains high levels of antioxidants and fiber and avoidance of simple sugar so what we've seen so far in this lesson it looks like Mediterranean diets should be a very good option for non-alcoholic fatty liver disease and in fact with regards to other medical conditions Mediterranean diets have been shown to improve metabolic syndrome obesity and type 2 diabetes Mediterranean diets have been associated with the following in non-alcoholic
fatty liver disease a decreased incidence of non-alcoholic
fatty liver disease decreased severity of non-alcoholic fatty liver disease reduction in body weight and reduced liver enzymes so reduced evidence of liver inflammation so all very important and a lower degree of steatosis so a lower degree of fatty infiltration of the liver so the Mediterranean
diet very good for non-alcoholic fatty liver disease and other types of medical conditions as well the next diet we're going to talk about is the ketogenic diet so
this comes from the review article entitled low carbohydrate ketogenic diets glucose homeostasis and non-alcoholic fatty liver disease so ketogenic diet is a high fat low carbohydrate diet and the carbohydrates are less than 50 grams per day in order to attain ketosis so there's actually been some mixed evidence with regards to ketogenic diet on liver health and functioning some evidence that ketone bodies reduce liver or hepatic inflammation now some of the mixed evidence seems to be due to the type of ketogenic diet that is used so either high fat ketogenic diet versus very low carbohydrate ketogenic diet so with regards to the differences between
two both of these kinetogenic diets have a low carbohydrate level so less than 50 grams per day but with the high-fat ketogenic diet the caloric intake or the amount of fats that can be consumed there's no limit to it with regards to the very low carbohydrate ketogenic diet there is so the evidence I'm going to present here is from high-fat ketogenic diets and that's where we see the most significant evidence or significant improvements in non-alcoholic fatty liver disease so potential benefits of the ketogenic diet especially the high-fat ketogenic diet include weight loss decreased evidence of liver inflammation decreased triglyceride content in the liver
and particularly when it's a Mediterranean and high fat ketogenic diet very good evidence for improvement
however, there may be some potential risks of worsening or inducing non-alcoholic fatty liver disease with ketogenic diets and that comes from this case report entitled ketogenic diet-induced elevated cholesterol elevated liver enzymes and potential non-alcoholic fatty liver disease so although there is some evidence supporting ketogenic diet in improving non-alcohol fatty liver disease and outcomes of non-alcoholic fatty liver disease there is some risk that there may be possible worsening of the non-alcohol fatty liver season but again
it could be due to the type of ketogenic diet.
Comments