Nonalcoholic steatohepatitis. FATTY LIVER.

Nonalcoholic steatohepatitis (NASH) is characterized by lobular inflammation, hepatositos shaped balloon (ballooning) and fat accumulation in liver cells; is currently very common entity may be suspected in patients with risk diseases (obesity, dyslipidemia, metabolic syndrome, chronic hepatitis, diabetes mellitus etc.) with elevated ALT and hyper-echogenicity in liver or liver ultrasound and ultrasound diagnosis is confirmed liver biopsy which remains Gold Standard or standard glod diagnosis. Liver biopsy determines the degree of inflammation, necrosis and fibrosis (the latter also determined by liver Elastography) and prognosis. NASH is part of a larger entity that is non-alcoholic fatty liver disease (NAFLD) including in its early stages with or without steatosis and NASH inflamaciónleve which can progress to fibrosis and cirrhosis. Genetic, metabolic disorders and coexistence of antioxidant intake could cause patients develop inflation and thus fibrosis and cirrhosis. The prevalence of NASH is 2-3% and NAFLD is up to 30% of the world population constituting the most common liver disease worldwide.

Factors influencing the development of steatosis and NASH thus:

• Sedentary

• Increased consumption of calories

• Anything that causes hyperinsulinemia and increased peripheral insulin resistance (Overweight and Obesity).

• Genetic factors

All this causes an increase in hepatic lipid synthesis and release of free fatty acids from adipose tissue, in this state the liver is unable to metabolize all fatty acids leading to hepatic steatosis and increased oxidative stress increased oxidizing hepatocytes being increased production of free radicals in the cell organelles, and increases the lipid peroxidation leading to increased production of free radicals and increased peroxidation.

The treatment of non Alcolica steatohepatitis is based on preventing and treating these factors:

1. Avoid a sedentary lifestyle, it is recommended cardio moderate to severe least 40 minutes daily uninterrupted; mpinimo five days a week under supervisicion and marketing surveillance of a deportólogo or trainer to avoid injury and prior review of cardiopulmonary function.

2. Reduce calorie intake and especially refined sugars. (glucose, fructose, sucrose, ect) in excessive amounts and after 15 hours (3:00 pm)

3. Avoid soprepeso and Obesity

4. Treat dyslipidemia and hyperuricemia in a multifactorial

5. Increase intake of antioxidants.

Taking intoaccount that vitamin E is a powerful anti-oxidant intracellular Pivens study in which randomly administered 800 IU of vitamin E daily for 96 weeks to 84 patients and placebo-controlled study double-blind was found that the vitamin compared to placebo had a higher rate of improvement in Histological estatohepatitis nonalcoholic (43% vs 19% p = 0.001). This study found that after treatment with vitamin E increased ALT levels was suspended. No significant differences in terms of adverse effects of vitamin E compared to placebo. Another study showed histological improvement in NASH using vitamin E 400 IU IDB was the TONIC study, multicenter, double-blind, placebo controlled trial in which patients were randomly assigned to receive vitamin E (58 patients received 400 IU twice daily ), metformin (57 patients received 300 mg regimen twice daily) or placebo (58 patients) for 96 weeks. This study encontrpo the resolution of NASH was significantly higher in the group of patients treated with vitamin E compared with placebo group, this result was attributed to decreased hepatocellular ballooning, was found not improved fibrosis.

Apparently the chronic use of vitamin E at a dose of 400 IU daily may increase the incidence of prostate cancer, hemorrhagic stroke and total mortality in adults

Bibliography

  1. Sanyal AJ.et,al. Pioglitazone versus vitamina E versus placebo for the treatment of non-diabetic patiens with non-algohlic steatohepatitis, PIVENS trial  desig. Comtemp Clin Trials 2009; 30 (1): 88-96.
  2. Lavine JE, Schwimmer JB, Molleston JP, Scheimann AO, Murray KF, Abrams SH, et al  Treatment of nonalcoholic fatty liver diseases in children: TONIC trial design, Contemp Clin Trials 2010; 31(1): 62-70.
  3. Lavine JE, Schwimmer JB. Van Natla ML, et al. Effect pf vitamin or metformin for treatmen of nonalcoholic fatty liver diseaes in chlidren and adolescents . The tonic randomized controlled trial JAMA , 2011 ; 305 /16); 1659-68
  4. Markus S, Robert JG, Pamela MR, Christophe T, Tobias K. Effects of vitamin E on strokes subtypes: meta-analysis of randomized controlled trials . BMJ. 2010;341.
  5. Klein E.A . Thompson IM .Tangen CM , et al . Vitamin e and the risk of prostate cancer: The selenium and  vitamin a cancer prevention trial (select). JAMA 2011;306(14): 1549-56
  6. Jhonnathan FereneyVelez M. Gstavo Amador Crespo , Juan Carlos Restrepo G. MD. Tratamiento con vitamina E en pacientes con esteatohepatitis no alcohólica. Pag 397-403.

DR. GUILLERMO SEGUNDO PEREZ GONZALEZ. Internista Gastroenterólogo Bogotá. Enero 12 del 2015.

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