Reversión del estado de hígado graso no alcohólico por intervención dietética y de ejercicio en pacientes con síndrome metabólico

Resumen

Non-alcoholic fatty liver disease (NAFLD) is defined as the accumulation of hepatic fat in the absence of a coexisting etiology of chronic liver disease or a secondary cause of steatosis (drugs, significant alcohol consumption, or inherited or acquired metabolic states). It is one of the most common non-communicable diseases in the world and is a potentially serious liver condition that translates into significant health costs, economic losses, and a reduction in the quality of life related to health at a societal level. NAFLD is often recognized as the hepatic manifestation of the metabolic syndrome (MetS). The presence of MetS is the strongest risk factor for NAFLD and Non-Alcoholic Steatohepatitis (NASH). Diet and exercise interventions are the first line of treatment, with the primary goal of controlling body weight and cardiometabolic risk factors related to metabolic syndrome. In the early stages of NAFLD, a healthy diet and weight loss of at least 7% may be enough. In more advanced stages, high genetic risk or, in the presence of diabetes, an intensified lifestyle intervention reinforced with pharmacological treatment may be necessary. Management of NAFLD should consist of treating liver disease as well as associated metabolic comorbidities, such as obesity, hyperlipidemia, insulin resistance, and T2DM. However, no specific pharmaceutical product is currently approved by the Food and Drug Administration (FDA) for NASH. Drugs targeting inflammation and fibrogenesis are being investigated, but with limited clinical success. There are indications that diet may trigger or prevent hepatic lipid accumulation by influencing the interaction between the liver, intestine, and adipose tissue, independent of energy intake. The macronutrient composition of a diet is associated with the development of NAFLD/NASH. Therefore, diet plays an important role. Because weight loss and maintenance remain a significant challenge for many people, modifying diet composition with or without a calorie-restricted diet may possibly be a feasible and sustainable strategy for NAFLD management. The general objective of this doctoral thesis is to compare and evaluate the efficacy of dietary patterns in the progression, improvement, or reversal of NAFLD and MetS parameters with personalized interventions and increased energy expenditure in obese patients with at least three of the main features of the Metabolic Syndrome. The study includes adult patients, aged 40 to 60 years, with MetS and NAFLD diagnosed by ultrasound, who are participating in a 12-month intervention trial of lifestyle behavior modification. The results showed that patients with NAFLD and MetS, diagnosed by NMR, by adhering to personalized hypocaloric dietary interventions based on MedDiet and increasing physical activity can improve NAFLD. Moreover, the participants who showed high changes in adherence to the MedDiet, showed lower intrahepatic fat contents, decreased body weight, waist circumference, BMI, TG, systolic blood pressure and diastolic blood pressure. Taken together, the results highlighted the positive role of the personalized diet, based on Mediterranean Dietary pattern, on metabolic and liver health, for the reversal of intrahepatic fat contents, and improving the characteristics of metabolic syndrome.