CS 14 - NAFLD

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Stephen F Austin State University *

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Health Science

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Feb 20, 2024

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Name: Dung Tran NUTR 4379 – MNT II 14-1 Case 14 – Non-Alcoholic Fatty Liver Disease (NAFLD) 1. Define non-alcoholic fatty liver disease and non-alcoholic steatohepatitis (NASH). Non-alcoholic fatty liver disease (NAFLD) refers to a wide spectrum of liver disease ranging from steatosis; in other words, it develops in the absence of alcohol that causes fat to build up in the liver. Nonalcoholic fatty liver (NAFL) and nonalcoholic steatohepatitis (NASH) are types of NAFLD (Nelms et al, 456). NASH causes inflammation, swelling and liver damage due to the fat deposits in the liver. NASH may get worse and may lead to serious liver scarring, called cirrhosis, and even liver cancer (Mayo clinic, 2023). 2. What is the potential etiology(ies) of non-alcoholic fatty liver disease (NAFLD)? The potential etiologies of NAFLD are multifactorial including nutrition implications (fructose and dietary fat), gut microbiome, obesity, and type II diabetes. Moreover, the research could only indicate some inborn genetic contribution to the NAFLD development such as the metabolic disorder (Nelms et al, 457). 3. Are there common presenting signs and symptoms for NAFLD? How might the markers of metabolic syndrome be related to NAFLD? NAFLD often has no symptoms that are virtually asymptomatic, and diagnosis may have only occurred because of the testing or screening for an unrelated condition (Nelms et al, 456). It occurred in Mr. Kim’s case without symptoms and signs before he did a physical exam for his job. Hepatomegaly could be a common clinical sign, could be found from radiology exams. The elevated enzyme ALT and AST are common lab marker to indicate the liver disease. Metabolic disorders could be a potential reason for NAFLD, the cholesterol and lipid lab markers could help the diagnosis. 4. Explain the potential role of diet in the development of NAFLD. Specifically address the roles of simple sugars, fructose, and refined carbohydrates. Nutrition is considered both as a factor contributing to the etiology for NAFLD and as a component of treatment. People who have high calories and high sugar-sweetened beverage intake are higher in risk of NAFLD. Sugar such as fructose is a major subject for research since it has a potential impact on NAFLD. Fructose impacts the stimulation of the regulatory system that controls intrahepatic lipogenesis. Same as other simple sugars, they all affect the lipogenesis

14-2 in the liver, which could lead to the fat accumulating in the liver causing NAFLD. They also decrease the insulin sensitivity and increase the risk of fibrosis. Research shows that decreases of dietary fat could help reduce the risk of NAFLD (Nelms et al, 457). 5. What are the long-term consequences of NAFLD if the condition progresses? NAFLD patients could or not have NASH and cirrhosis in long- term consequence. If the patient has insulin resistance such as type II diabetes, the risk of getting inflammation is higher than normal. When patients get NASH, they are at risk of cirrhosis because scarring and fibrosis are present in this stage. Scar tissue will replace the inflammation cells and fat cause cirrhosis. But all these conditions progress depend on patients’ weight, and insulin status. Since Mr. Kim has already been diagnosed with hepatic steatosis, he is at risk of cirrhosis in the long term (Nelms et al, 456-457). 6. Describe the Mediterranean diet and how this eating pattern may support the nutritional goals of treatment of NAFLD. There is significant evidence to support the use of Mediterranean dietary principles to promote the intake of a lower fat, lower sugar, and higher fiber/prebiotic dietary intake. The low fat and low sugar diet could help regulate the lipid and sugar level in blood, decrease the effect on the NAFLD, and help reverse the disease. The higher fiber/prebiotic dietary intake impairs metabolism function and lower fat build up in the liver (Nelms et al, 458). 7. Mr. Kim asks you about an article he recently read about the benefits of coffee consumption in fatty liver disease. What recommendations might you give him? (Find an academic research journal from 2014 – 2023 to support your recommendations.) The research study is about the association between caffeine consumption and nonalcoholic fatty liver disease in 1452 people including 789 women and 663 men: average age 42.3 ± 12.8 years. The study proved a significant association between hepatic steatosis male gender (p < 0.0001), advanced age (p < 0.0001) and elevated body-mass index (BMI; p < 0.0001). There is no association between caffeine consumption and fatty liver was identified (Graeter et al, 2015). An association between caffeine consumption and elevated serum ALT concentrations was not identified. Although coffee has some benefits such as anti-inflammation and antioxidative effects

Name: Dung Tran NUTR 4379 – MNT II 14-3 which could be beneficial to fatty liver disease. But these are not directly related to treatment for NAFLD. It still needs evidence and research to improve the role of coffee. Thus, coffee doesn't help Mr. Kim in intervention from fatty liver disease. 8. Evaluate Mr. Kim's weight status. (Show calculations for IBW and %IBW.) 5’8” = 68 inches = 172.7cm BMI = 205lbs / (68 in) ² x 703 = 31.2 (Obese Class I) Male IBW = 106lbs + (6lbs x 8) = 154lbs (138.6lbs – 169.4lbs) %IBW = (205lbs/154bs) x 100% = 133% 9. Calculate Mr. Kim’s energy and protein requirements for weight maintenance and for weight loss. Utilize the Mifflin St-Jeor Equation for energy needs (TEE). Show calculations! Due to his obese class I, adjust BW = [(205lbs – 154lbs) x 0.25] + 154lbs= 166.75 = 167lbs (76kgs) Mifflin-St. Jeor Equation (10 x 76kgs) + (6.25 x 172.7 cm) – (5 x 38) + 5 = 1654.4 = 1655kcal (REE) Patient are diagnosed Hepatic steatosis - NAFLD and obesity need to be focused on weight loss, but this disease goes with other inflammation conditions that could be consider under stress and need more energy. However, He is in no apparent distress. 1655kcal x 1.2 – 1.3 (stress factor) = 1986 – 2151,5 = 1986kcal/day - 2152kcal/day (TEE) Protein requirements 1.2 g/kg x 76kgs = 91.2 grams protein/day 10. What other anthropometric measurements, if any, may be helpful in fully assessing Mr. Kim's nutritional status and disease risk? Other anthropometric measurements may be helpful in fully assessing Mr. Kim's nutritional status and disease risk is BMI. His BMI is 31.2, Obese Class I, which means he is related to excess energy intake, and at risk of CVD, diabetes, and metabolic syndrome.

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