Non Alcoholic fatty liver disease (NAFLD) and lifestyle interventions

We know that obesity is a risk factor for several non communicable diseases, it can lead to diabetes and other metabolic conditions, but there is less awareness that obesity can lead to serious liver disease.It is estimated up to 1 in every 3 people in the UK has early stages of NAFLD, where there are small amounts of fat in their liver.

Non-alcoholic fatty liver disease is the accumulation of triglycerides in the liver cell and this buildup is independent of alcohol consumption. It is a spectrum of disorder ranging from less severe steatosis (fatty liver) to more severe non-alcoholic steatohepatitis (NASH), where the liver has become inflamed; this is estimated to affect up to 5% of the UK population. Fibrosis and cirrhosis develop at later stages and lead to liver failure and sometimes liver carcinoma.

what causes NAFLD

  • The exact cause of NAFLD remains unclear, however, it is linked with genetic and environmental factors like
  • 1.Obesity
  • 2.Diabetes
  • 3.Hyperlipidemia
  • 4.Women with PCOS5.
  • 5.Sedentary lifestyle

Treatment and prevention

There is no specific pharmacological treatment for NFALD. However, various medicines can be useful in managing the problems associated with the condition like;medications for high cholesterol, high blood pressure and Insulin sanitizers.

Life style modifications;

There is a strong consensus that lifestyle interventions such as diet, physical activity and weight reduction can help in preventing and reduces the progression of the disease. A metanalysis of 23 trials shows that lifestyle modification including weight loss and physically activity consistently reduced liver fat and improved histopathology.

WELL BALANCED DIET; Diet consists of vegetables and fruits with less processed carbohydrates. Low Glycemic index carbohydrates with more fibre content also reduce insulin resistance which is directly linked with NAFLD. Low caloric diet intake ( 3-6 months) either low carbohydrates or low fat diet results in weight loss and improved lipid profile.

Intake of polyunsaturated fats especially omega 3 fatty acids reduces the risk of NAFLD. Mediterianean diet is a best source of mono unsaturated fatty acids( MUFA) like n– oleic acid (olives, nuts, avocado), which play an important role in the metabolic profile of human metabolism. MUFA has been demonstrated a beneficial effect on lipid profile bt decreasing  plasma triacylglycerol and very low density lipoprotein (VLDL) cholesterol concentrations and modestly increasing high density lipoprotein (HDL) cholesterol without adversely affecting low density lipoprotein (LDL) cholesterol concentrations. 

Soft drinks are leading cause of added sugars in the world and different observational studies report a positive association between soft drink consumption and NAFLD. Soft drinks like cola drinks contain caramel coloring, which is rich in advanced glycation end products (AGEs) that may increase insulin resistance and inflammation.

Observational studies have demonstrated a favourable impact of coffee intake on health and in particular a protective effect from the metabolic syndrome. Coffee contain polyphenols chlorogenic acid which acts as antoxidants, anti inflammatory and reduces the risks of developing NAFLD and cardiovascular diseases.

Regular physical activity: There is a dose-response relationship between NAFLD and physical activity (both prevalence and disease severity,  therefore, the more physical activity performed throughout the day, the better! Aim to do at least 150 minutes/week of physical activity like walking or cycling. Increasing daily walking has also been shown to improve fat oxidation and is a way of increasing physical activity levels at no cost and without additional equipment. Aerobic and resistance exercises both improves NAFLD. A systematic review (24 exercise-only studies) revealed that exercise produced a 20–30% relative reduction in hepatic steatosis, independent of weight loss in NAFLD patients.

weight reduction: Based on available data, patients should optimally achieve a 5%-10% weight reduction. A prospective study with 7 years of follow up emphasized that even a modest weight change of 3–5 kg is an independent predictor for the development and remission of NAFLD, regardless of baseline body mass index (BMI).

TAKE-HOME MESSAGE

Lifestyle interventions can be highly effective in treating NAFLD across the disease spectrum and offer a holistic way of managing not only liver health, but also cardiovascular and metabolic health. Patients often feel difficult to achieve and implement these modifications, however with proper and individualized support suffient long term changes can be possible.

always set Smart, Meaurable, Achievable, Relevant, Timely goals

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