Liver Disorder: Signs, Roots, Management, Prognosis, and Perspectives
Nonalcoholic steatohepatitis (NASH), a more serious form of nonalcoholic fatty liver disease (NAFLD), is a growing health concern affecting a significant portion of the global population. Characterized by liver inflammation along with fat accumulation, NASH can lead to liver damage such as swelling, scarring, cirrhosis, and even liver cancer if left untreated.
In many cases, NASH presents no noticeable symptoms in its early stages. However, when symptoms do appear, they usually include pain or discomfort in the upper right abdomen, fatigue or weakness, and fluid buildup and swelling in the abdomen and legs.
The primary and most effective treatment approach for NASH involves lifestyle changes focused on gradual weight loss. Losing as little as 3-5% of body weight can reduce liver fat, and losing 7-10% can reduce inflammation and liver injury. This weight loss is typically recommended over a period of one year rather than through rapid weight loss, which may worsen the condition.
Emphasis is placed on healthy, balanced diets such as the Mediterranean diet, which is rich in fruits, vegetables, whole grains, lean protein, and healthy fats. Increasing exercise to support weight loss and improve metabolic health is also recommended.
In addition to lifestyle changes, medication options have shown promise in managing NASH. Glucagon-like peptide-1 (GLP-1) receptor agonists and dual GIP/GLP-1 agonists like tirzepatide have been found to reduce liver fat and inflammation and improve fibrosis. SGLT-2 inhibitors have shown benefits for liver fat and metabolic parameters, while statins are recommended for managing cardiovascular risk and can improve liver biochemistry.
However, it's important to note that not all medications are recommended for NASH treatment. For instance, pentoxifylline is not recommended.
In summary, managing NASH centers on controlling metabolic risk factors through lifestyle modification as a foundation, supplemented by newer medication options under clinical guidance to reduce liver inflammation and prevent progression to more severe liver disease.
Researchers also suggest that consuming prebiotic fiber found in leeks, asparagus, and other plant foods, and probiotic-enriched yogurt, and opting for plant-based protein may help manage the intake of calories and boost gut microbiota health for people with NAFLD.
It's estimated that about one-third of adults in the United States may have NAFLD but no inflammation or damage, while about one-third of people with NASH develop cirrhosis and liver failure. NAFLD is often developed alongside obesity, high blood pressure, diabetes, and high cholesterol, making it crucial to manage these conditions to reduce the risk of developing NASH.
[1] https://www.niddk.nih.gov/health-information/liver-disease/nonalcoholic-fatty-liver-disease/definition-facts [2] https://www.liverfoundation.org/for-patients/about-the-liver/disease-listing/nonalcoholic-steatohepatitis/ [3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7310578/ [5] https://www.niddk.nih.gov/health-information/liver-disease/nonalcoholic-steatohepatitis/treatment
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