Eficácia e segurança de mudanças no estilo de vida na Esteatose Hepática não Alcoólica: revisão rápida de evidências / Effectiveness and safety of lifestyle modifications for Nonalcoholic Hepatic Steatosis: rapid response review of evidence

Tecnologia: Intervenção de mudança no estilo de vida (dieta, exercícios). Indicação: doença hepática gordurosa não alcoólica (DHGNA). Pergunta clínica: Intervenções de mudança no estilo de vida, comparados a nenhum tratamento ou placebo, são eficazes no tratamento de DHGNA para modificar indicadores metabólicos, reduzir mortalidade e prevenir complicações relacionadas à esteatose hepática? Métodos: Foi feito levantamento bibliográfico na base de dados PUBMED, seguindo estratégias de buscas predefinidas. As revisões sistemáticas foram avaliadas com a ferramenta "AMSTAR 2 - Assessing the Methodological Quality of Systematic Reviews version 2". Resultados: Foram selecionadas 4 revisões sistemáticas, que atendiam aos critérios de inclusão. Conclusão: As evidências disponíveis não são suficientes para confirmar ou refutar que as modificações do estilo de vida têm efeitos benéficos de longo prazo sobre a DHGNA. Protocolos com dieta mediterrânea, jejum intermitente ou exercícios aeróbicos são benéficos para reduzir parâmetros metabólicos em pessoas com DHGNA

Technology: Lifestyle change intervention (diet, exercise). Indication: Non-alcoholic fatty liver disease (NAFLD). Clinical question: Are lifestyle change interventions, compared to no treatment or placebo, effective in NAFLD treatment to modify metabolic indicators, reduce mortality and prevent complications related to hepatic steatosis? Methods: A bibliographic survey was carried out in the PUBMED database, following predefined search strategies. Systematic reviews were evaluated using the tool "AMSTAR 2 - Assessing the Methodological Quality of Systematic Reviews version 2". Results: 4 systematic reviews that met the inclusion criteria were selected. Conclusion: The available evidence is not sufficient to confirm or refute that lifestyle modifications have long-term beneficial effects on NAFLD. Protocols such as a Mediterranean diet, intermittent fasting, or aerobic exercise are beneficial in reducing metabolic parameters in people with NAFLD

Lychee (Litchi chinensis Sonn) peel flour: effects on hepatoprotection and dyslipidemia induced by a hypercholesterolemic diet

ABSTRACT Dyslipidemias are associated with the incidence of cardiovascular diseases, obesity, diabetes, hypertension and hepatic steatosis, being the cause of morbidity and mortality. This study investigated the effects of lychee peel flour (PF) on serum levels of total cholesterol (TC), low-density lipoprotein (LDL-c), triacylglycerols (TAG) and various parameters related to obesity, in rats fed a hypercholesterolemic diet. Therefore, 20 male rats were used. In the first 21 days, the animals were fed a hypercholesterolemic diet, except for control group. In the following 21 days, their diets were modified, and they received a standard diet (Control); hypercholesterolemic (Hyper); hypercholesterolemic + 5% PF (PF5) and hypercholesterolemic + 10% PF (PF10). The results revealed that PF intake attenuated weight gain, reduced body mass index, glucose and the levels of TAG, TC, LDL-c, hepatic enzymes and leptin, besides the percentage of hepatic lipids, liver lipid peroxidation and frequency of severe steatosis. Histological studies of the aorta did not show the formation of the atheromatous plaque. These results reinforce its potential to reduce the risk of diseases associated with obesity.

Efecto del extracto purificado rico en antocianinas del fruto del maqui (Aristotelia chilensis) en un modelo experimental de hígado graso no alcohólico / Effect of a purified anthocyanin-rich extract of maqui (Aristotelia chilensis) on experimental model of nonalcoholic fatty liver disease

Background: Non-alcoholic fatty liver disease (NAFLD) is a spectrum of hepatic lesions, ranging from benign intrahepatic lipid accumulation (steatosis) to progressive non-alcoholic steatohepatitis, in absence of other known secondary causes. Both insulin resistance and oxidative stress have been involved in NAFLD development and progression and, therefore, insulin-sensitizers and/or antioxidants have been targets of different therapeutic agents. Some natural compounds such as Aristotelia chilensis have a high content of polyphenols, which are known for their antioxidant and anti-inflammatory properties. Objective: To assess the effect of a purified anthocyanin-rich extract of maqui (Aristotelia chilensis) on experimental model of NAFLD. Methods: C57BL6 mice were separated in four experimental groups (n = 4-10) and fed a control diet (chow) or a high fat diet (HFD) with or without a purified anthocyanin-rich extract of Aristotelia chilensis (ACnE) (400 mg/kg/day diluted in drinking water). The hepatic effects of HFD were assessed measuring serum levels of glucose and aminotransferases, hepatic histology and triglycerides. Results: HFD diet induced an increase in hepatic triglycerides and histological NAFLD. Administration of ACnE did not affect serum aminotransferases, hepatic triglycerides, liver weight or histological NAFLD. Conclusion: Administration of an ACnE showed no effects on NAFLD in the HFD experimental model.

Introducción: El hígado graso no alcohólico (HGNA) constituye un espectro de lesiones hepáticas, desde la acumulación lipídica intrahepática benigna (esteatosis) hasta la esteatohepatitis no-alcohólica progresiva, en ausencia de causas secundarias conocidas. En el desarrollo y la progresión del HGNA se ha involucrado la resistencia a insulina y el estrés oxidativo y, por lo tanto, insulino-sensibilizantes y antioxidantes han sido blancos de diferentes agentes terapéuticos. Algunos compuestos naturales como la Aristotelia chilensis (maqui) tienen un alto contenido de polifenoles, los que presentan propiedades antiinflamatorias y antioxidantes. Objetivo: Evaluar el efecto de un extracto purificado rico en antocianinas (EACn) del fruto del maqui (Aristotelia chilensis) sobre la esteatosis, en un modelo experimental de HGNA. Métodos: Los ratones fueron distribuidos en 4 grupos (n = 4-10). Dos alimentados con una dieta estándar (grupo control) y dos con una dieta alta en grasa- high fat diet (grupo HFD). Un grupo control y uno HFD recibieron además 400 mg/kg/día de EACn (grupo EACn). Se determinaron los niveles séricos de aminotransferasas y glucosa; se evaluó la histología hepática y el contenido hepático de triglicéridos. Resultados: HFD indujo aumento de triglicéridos hepáticos e HGNA histológico. La administración de EACn no modificó las transaminasas séricas, los triglicéridos hepáticos, el peso del hígado ni el HGNA histológico. Conclusiones: La administración de un EACn no mostró efectos en el modelo experimental de HGNA inducido por una dieta alta en grasa.

Dietary patterns in Brazilian patients with nonalcoholic fatty liver disease: a cross-sectional study

OBJECTIVE: Recent evidence suggests that non-alcoholic fatty liver disease is associated with diet. Our aim was to investigate the dietary patterns of a Brazilian population with this condition and compare them with the recommended diet. METHODS: A cross-sectional study was conducted on 96 non-alcoholic fatty liver disease patients before any dietetic counseling. All patients underwent abdominal ultrasound, biochemical tests, dietary evaluations, and anthropometric evaluations. Their food intake was assessed by a semi-quantitative food-frequency questionnaire and 24-hour food recall. RESULTS: The median patient age was 53 years, and 77% of the individuals were women. Most (67.7%) participants were obese, and a large waist circumference was observed in 80.2% subjects. Almost 70% of the participants had metabolic syndrome, and 62.3% presented evidence of either insulin resistance or overt diabetes. Most patients (51.5, 58.5, and 61.7%, respectively) exceeded the recommendations for energy intake, as well as total and saturated fat. All patients consumed less than the amount of recommended monounsaturated fatty acids, and 52.1 and 76.6% of them consumed less polyunsaturated fatty acids and fiber, respectively, than recommended. In most patients, the calcium, sodium, potassium, pyridoxine, and vitamin C intake did not meet the recommendations, and in 10.5-15.5% of individuals, the tolerable upper limit intake for sodium was exceeded. The patients presented a significantly high intake of meats, fats, sugars, legumes (beans), and vegetables and a low consumption of cereals, fruits, and dairy products compared with the recommendations. CONCLUSIONS: Although patients with non-alcoholic fatty liver disease exhibited high energy and lipid consumption, most of them had inadequate intake of some micronutrients. The possible role of nutrient-deficient intake in the development of non-alcoholic fatty liver disease warrants investigation.

The Role of Diet in Non-alcoholic Fatty Liver Disease / 대한소화기학회지

Prevalence of non-alcoholic fatty liver disease (NAFLD) is about 20-25% in Korean adults population. Obesity is strongly associated with NAFLD and the prevention of obesity is a major public issue. Unfortunately, pharmacological treatment of obesity and NAFLD remains uncertain. Only weight loss by dietary changes been shown to lead to histological improvement in fatty liver. So the nutrition therapy is a cornerstone of treatment for NAFLD. Epidemiologic studies show that saturated fat, trans-fatty acid, carbohydrate, and simple sugar have strong correlation with intrahepatic fat accumulation. But, true associations with specific nutrients still remain unclear. Recently, fructose consumption has been rising in many countries and several epidemiologic studies show that fructose consumption has strong correlation with metabolic diseases. The consumption of excessively added sugar in the pathogenesis of steatohepatitis has received attention. Most clinicians agree with lifestyle modification are effective in histologic improvement. Total energy intake restriction is the most important action to reduce intrahepatic fat accumulation. Macronutrient composition may also have correlation with the development of NAFLD. To reduce the incidence of NAFLD, public statements on optimal dietary education program have been issused. Various specific dietary programs are suggested. Among them low fat diet and low carbohydrate diet are suggested in patients with NAFLD. However, there is no ideal diet to obtain the histological improvement in NAFLD. Further randomised controlled studies about specific diet are needed to determine the long-term benefit and histological improvement by ideal diet. Tailoring diet therapy to a patient's lifestyle is more important than universal specific dietary program.

Preventive role of fresh garlic on high-fat diet induced fatty liver in albino rats

Obesity has become a worldwide problem due to westernization of diet, even in developing countries leading to consumption of high-fat diet. One of the most common diseases resulting from use of high-fat diet is fatty liver. Garlic is one of the oldest herbs used for medicinal purposes since ancient times. So the present study was undertaken to observe the protective role of fresh garlic on high-fat diet induced fatty liver in albino rats and correlate the results with previous studies. Thirty adult albino rats, weighing from 200-240 gram were taken for this study. The rats were divided into 3 groups according to dietary regimen, Group A received control diet, Group B received high- fat diet [20 ml corn oil in 100 gm of diet] and Group C received high-unsaturated fat diet with fresh garlic [20 ml corn oil with 6 gm fresh garlic in 100 gm of diet], for 8 weeks at the end of which they were sacrificed and tissue slides stained with haematoxylin and eosin. There was marked increase in weights in rats receiving high fat diet. Haematoxylin and eosin stained sections showed moderate fatty infiltration with empty spaces in hepatocytes with absent or pyknotic nuclei in high-fat group which were preserved to a great extent in group receiving fresh garlic along with high-fat diet. This study has proved that use of fresh garlic along with high-fat diet prevents its damaging effects in liver to a great extent

Fibras solúveis no tratamento da doença hepática gordurosa não-alcoólica: estudo piloto / Non alcoholic fatty liver disease: treatment with soluble fibres

O presente estudo piloto avaliou a eficácia de fibras solúveis no tratamento da doença hepática gordurosa não-alcoólica. Foram incluídos 12 pacientes que receberam 10 g/dia de fibras solúveis oral por 3 meses. Após o tratamento, observou-se redução nos valores do índice de massa corporal, circunferência da cintura e resistência à insulina em 100 por cento dos casos, redução nos níveis de colesterol em 66,7 por cento e normalização de ALT, AST e GGT em 75 por cento. Os resultados sugerem que a utilização de fibras solúveis pode colaborar no controle de fatores de risco e das enzimas hepáticas em pacientes com doença hepática gordurosa não-alcoólica e estimulam a realização de estudos controlados envolvendo controle histológico.

The pilot study evaluated the efficiency of oral soluble fibers to treat patients with nonalcoholic fatty liver disease. Twelve patients received 10 g/day of soluble fibers during 3 months. After the treatment 100 percent of patients presented reduction in body mass index, waist circumference and insulin resistance index. In 66.7 percent of the patients were observed reduction of the cholesterol levels and 75 percent presented normal liver enzymes (AST, ALT, and GGT). The present study suggests that oral soluble fibers may be useful to control risk factors and liver enzymes in patients with nonalcoholic fatty liver disease. However, future studies with histological controls are considered necessary.

[Non-alcoholic steatohepatitis [NASH]]

The term "Non- Alcoholic Steatohepatitis [NASH]" is applied when sonographic and pathologic view of liver shows alcoholic hepatitis changes without history of alcohol consumption. Radiologic findings can easily make the diagnosis and liver biopsy confirms the initial suspicion. It is showed that up to 43.5% of patients with asymptomatic abnormal liver transferases levels have some degrees of NASH, which suggest the importance of being familiar with the issue and how to approach and treat it. NASH is commonly accompanied with diabetes mellitus [especially type II], obesity and hyperlipidemia. These findings support the theory in which insulin resistance is the mainstay of NASH pathophysiology. The natural history of NASH is unclear but surely it is far better than alcoholic related liver disease. It is estimated that up to 8% of patients would meet cirrhosis, considering risk factors such as obesity and features found in biopsy specimen. Steatosis, polymorphonuclear lobular inflammation, ballooning degeneration, hyaline- Mallory bodies and cirrhosis are among different pathologies seen in biopsy. It is important to rule out other chronic liver diseases including drug induced liver disease, chronic viral hepatitis, and metabolic and autoimmune liver diseases to establish the diagnosis of NASH. There is no definite treatment for NASH. Therapeutic measures are categorized as reducing risk factors and using hepatocellular protective agents. The former includes weight reduction, treating hyperinsulinemia and diabetes, control of hypertriglyceridemia and leptin. Protective agents are anti-oxidants like vitamin E and/ or C, probucol, silymarin, ursodeoxycholic acid, reducing iron load, N-acetyl cystein, food supplements and cytokines. Increasing rate of NASH is reported among children and adolescences, which could be due to growing amount of obesity in these age groups

La dieta terapéutica en la esteatosis hepática / Diet therapy in liver steatosis

El objetivo de este estudio fue evaluar una dieta que contiene el 25 porciento de la energía en forma de grasa (G:25 porciento) como tratamiento de la esteatosis hepática. Se estudiaron 44 individuos adultos que presentaban esteatosis hepática diagnosticada por ultrasonido abdominal. Se midió el índice de masa corporal, las concentraciones de colesterol y triglicéridos en suero, y se hicieron pruebas funcionales hepáticas al comienzo y al final del estudio. A todos los pacientes se les prescribió una dieta G:25 porciento y, a los que además tenían un índice de masa corporal de 25 kg/m2 o más, una dieta con dicho contenido de grasa y con un aporte energético de 25 a menos de 30 kcal/kg de peso corporal (E:25<30kcal/kg). Los pacientes fueron evaluados mensualmente hasta el término de 1 año. Ningún paciente empeoró según la escala de clasificación. Nueve de los 18 pacientes que presentaron esteatosis intensa al inicio, tuvieron esteatosis moderada al final del estudio. Nueve de los 15 pacientes evaluados como esteatosis moderada al inicio, fueron evaluados después como esteatosis ligera unos y curados otros. Siete de los 11 individuos que habían tenido esteatosis ligera al inicio del estudio, resultaron curados. La dieta terapéutica utilizada mejoró la esteatosis hepática