Fatty hepatosis (steatosis of the liver, steatohepatosis) is a chronic liver disease characterized by histopathological changes in liver tissue in the form of fat accumulation, mainly triglyceridesIn hepatocytes, which in some cases passes into inflammation of the liver (steatohepatitis) and the development of fibrosis (steatofibrosis). At present, fatty hepatosis of alcoholic and non-alcoholic genesis is isolated.
The leading role in the development of fatty hepatosis against the background of alcohol consumption is played by the toxic product of the metabolism of ethanol – acetaldehyde, which reduces the activity of enzymes that transport fatty acids in the mitochondria, which leads to a disruption in the metabolism of fats and subsequent accumulation of triglycerides in the liver cells. The main etiological factors of non-alcoholic hepatosis are combinations of various metabolic risk factors (abdominal obesity, hyperglycemia, hypercholesterolemia, arterial hypertension, diabetes mellitus 2 type), viral hepatitis, taking certain medications (glucocorticosteroids, methotrexate, tetracycline, amiodarone, tamoxifen, estrogens and others), rapid weight loss / fasting.
Due to the high risk of developing fibrosis and cirrhosis of the liver, regardless of the severity of the disease, all patients with fatty hepatosis need treatment and follow-up. However, there is no standardized therapeutic approach to the management of such patients, nor is there a clear understanding of how to treat fatty liver hepatosis.
Nutrition treatment (diet with restriction of digestible carbohydrates and animal fats) combined with lifestyle modification (increased physical activity, normalization of body weight, rejection of harmful habits, alcohol / smoking abuse) against hepatoprotective therapy – prescribing antioxidants and hepatoprotectors (vitamin E, ursodeoxycholic acid, silibinin, betaine, a-lipoic acid) allows you to achieve a positive result. As a rule, in uncomplicated cases with normal indicators of biochemical tests and a known etiology of the disease, regression of fatty liver disease is observed through 4-6 months.
Therapeutic nutrition for fatty liver hepatosis in patients with increased body weight /obesity, first of all, should be directed at its normalization. For this purpose, a hypocaloric diet is prescribed with an individual selection of the energy value of the food ration depending on the age, body weight, level of physical activity, sex. For this purpose, special formulas are used to calculate the calories needed to maintain the basal metabolism, which are multiplied by the physical load factor, which is the caloric content of the daily ration. From this calculated value, 500-700 kcal is subtracted to reduce body weight.
However, at the same time, the minimum daily ration should not be less than 1500 kcal / for men and 1200 kcal for women. Patients should be cautioned against trying to lose weight quickly, as rapid weight loss can lead to the development of “acute” steatohepatitis with the formation of fibrosis against the background of the inflammatory process, caused by the increase in the intake of free fatty acids into the liver against a background of relatively low peripheral lipolysis.
The benchmark for safe / effective weight loss are the indices: 1500 g / week for adults and 500 g for children. Patients with severe obesity (exceeding body weight by more than 20% of the norm) are prescribed a curative Diet №8 on Pevzner. The correlation of decrease in body weight by 5-10% with regress of fatty hepatosis of the liver was reliably confirmed. Diet for fatty hepatosis provides:
- Restriction in the diet of fats to 30% of the total caloric intake.
- The ratio of polyunsaturated / saturated fatty acids in the diet should be more than 1, which is achieved by excluding from the diet of solid animal fat, butter, fatty meat and increasing products containing polyunsaturated fatty acids (seafood, vegetable unrefined oil, nuts, marine / river fish, dietary poultry, olives);
- decrease in consumption of products containing a large number of cholesterol (not more than 300 mg / day). For this purpose, offal (liver, kidneys), egg yolk, red caviar, fatty meats, dairy products, and smoked products are excluded from the diet.
- The exclusion of such methods of cooking food, as well as frying, deep-frying.
- Enrichment of the diet with vitamins and prebiotic foods (vegetables / fruits, artichoke, Jerusalem artichoke, leeks).
- For patients diabetes and with a violation of glucose tolerance in the diet, simple carbohydrates are excluded and complex ones are limited, which helps improve metabolism.
Treatment of fatty hepatosis of alcoholic etiology requires an additional appointment to basic therapy of water-soluble of PP vitamins, V1, V6, С, V2, V12, administered parenterally in conventional therapeutic doses for 2 weeks.
Exceptions are products that are rich in purines, cholesterol, nitrogenous extractives, essential oils, oxalic acid and by-products of fat oxidation formed during frying / deep-frying.
In the diet, the content is increased pectins, lipotropic substances, fiber, free liquid. Methods of cooking products – cooking, baking, quenching. Meat / fish fatty varieties, smoked meats, canned foods, sausages, broths, legumes and vegetables, containing large quantities of essential oils – all kinds of radish / radish, garlic and onion in raw form, spicy spices, marinades, spices and sauces, vinegar , fat milk / cream, cakes, cakes, buns.
In addition to the permitted products, it is necessary to include foods that improve liver function in the diet:
- Artichoke – lowers cholesterol / normalizes the outflow of bile.
- Leafy greens, vegetables and fruits. Especially useful is the pumpkin and dishes based on it, pumpkin juice. It is well digested and discharges the liver.
- Vegetables (carrots, beets, sweet peppers) are rich in beta-carotene, from which it is synthesized vitamin A.
- cabbage improves the detoxification function of the liver.
- fruit (dog rose, black currant, citrus) – contain in large amounts of antioxidants that stop the processes of oxidation and damage to cells.
- Cereals (oatmeal / buckwheat) contain vitamins group B и RR, important for liver function.
- Vegetable oils of cold pressing, nuts. Contain in large quantities of antioxidant- vitamin E and fattyomega-3acids, which protect cell membranes from death.
- Dried fruits, especially dried apricots, containing potassium and magnesium.
- Fermented milk products with low fat content (natural yoghurt, kefir, acidophilus, fermented baked milk). They normalize the biocenosis of the intestine, and cottage cheese is rich in lipotropic substances.
- Honey – promotes the recovery of hepatocytes and activates the production of bile.
- Free liquid in an amount not less than 1,5-2 l / day from which it is derived Toxins. Improve the detoxification ability of the liver and the processes of its self-purification, the addition of citrus fruit juice into the water.
Diet for hepatosis of the liver provides for inclusion in the diet:
- Vegetable broths and soups based on them with the addition of cereals, vermicelli, vegetables.
- Low-fat varieties of red meat (beef / veal) rabbit, chicken, turkey. Meat should be pre-boiled and then cooked.
- Yesterday’s / dried wheat bread to 500 g per day. With good tolerability – rye bread, low-fat cookies, dry biscuit.
- Low-fat species of sea / river fish baked with vegetables.
- Croup in the form of casseroles, cereals.
- Fermented milk products of low fat content: yogurt, kefir, bifidum-kefir, acidophilus and not fatty cottage cheese.
- Milk / sour cream only as an additive to ready meals.
- Chicken eggs in the form of a steam omelet / soft.
- Fresh, baked and stewed vegetables in the form of salads with the addition of vegetable oil, puree and squash home-made caviar. From spices – vegetable greens, caraway seeds, bay leaves.
- Sour-milk and vegetable sauces.
- Non-acid fruit / berries in fresh and processed form (jelly, compotes, mousses).
- Marmalade, honey, caramel, marshmallows, jams, iris. Sugar is partially replaced with xylitol.
- Butter / vegetable oil is added only to ready meals, their heat treatment is excluded.
- Table water without gas, rose hip infusion, weak tea, vegetable juices, broth of wheat bran, coffee with milk (not strong).