The holiday season can be notoriously harsh for the liver, as diets are abandoned and alcoholic beverages are reduced. They also provide an ideal time to remind us that alcoholic and non-alcoholic fatty liver disease (NAFLD), the most common liver disease in the industrialized world,[1] it can be prevented by adopting interventions on a healthy lifestyle. Here are five approaches to help patients change their risk factors this new year.
1. Reduce calories strategically.
Caloric restriction can reduce insulin resistance, weight, liver fat, and cardiovascular risk factors, regardless of carbohydrate content.[2,3]
While we may have overdosed during the holiday season, different strategies for achieving caloric restriction can help us get back on track, including fasting diets such as time-restricted foods (meals that are consumed in limited numbers). hours), alternate fasting, and the 5: 2 food pattern (unrestricted eating for 5 days, followed by 2 days of restricted intake).
Intermittent fasting may not be safe for all patients, especially those with diabetes or cirrhosis, in whom fasting increases the risk of sarcopenia. Physicians should guide patients and remind them to be careful in weight reduction, as recent studies suggest that moderate to large weight loss increases the risk of mortality in patients aged 45 to 74 years.[4]
2. Exercise towards a healthier liver.
Increased physical activity has been shown to reduce liver fat concentration and increase aspartate aminotransferase and alanine aminotransferase levels, in addition to improving insulin sensitivity.[1,5]
Following the implementation of an exercise program, invasive and non-invasive measures have shown a decrease in intrahepatic fat.[6] Exercise alone, without additional dietary modifications, also leads to better hepatic steatosis.[7]
Exercise has many other associated health benefits. Regardless of how it is achieved, weight loss of at least 7% can lead to remission of NAFLD in obese and non-obese patients.[8] And the type of exercise may not matter, as aerobic and endurance training has been shown to reduce liver fat.[7]
3. Celebrate dry January (or sober September).
The concept of “dry January” —or abstinence from alcohol during the first month of the new year — has grown in popularity. Evidence suggests that it is a trend that patients would benefit from adoption.
Mehta and colleagues[9] it was found that 1 month of abstinence resulted in significantly improved insulin resistance, blood pressure, weight, lipid profile, and liver function tests, compared with a control group that continued to consume alcohol. At 6 months, a significant reduction in alcohol consumption persisted in the abstinence group. The researchers found that abstinence even caused a decrease in the expression of vascular endothelial growth factor and epidermal growth factor, key molecules in the development of cancer.
These results suggest that even short-term alcohol withdrawal can have significant effects on both liver health and overall health, especially because alcohol use and insulin resistance are the main causes. of steatohepatitis. This effect can lead to increased health awareness, given the subsequent decline in alcohol consumption even months later.[9,10,11]