Nutrition and Nonalcoholic Fatty Liver Disease: The Significance of Cholesterol

Nonalcoholic fatty liver disease (NAFLD) is a common chronic liver disease that ranges in severity from simple steatosis to cirrhosis. NAFLD is considered to be associated with hepatic metabolic disorders, resulting in overaccumulation of fatty acids/triglycerides and cholesterol. The pathogenesis and progression of NAFLD are generally explained by the “two-hit theory.” Most studies of lipid metabolism in the NAFLD liver have focused on the metabolism of fatty acids/triglycerides; therefore, the impact of cholesterol metabolism is still ambiguous. In this paper, we review recent studies on NAFLD from the viewpoint of hepatic lipid metabolism-associated factors and discuss the impact of disordered cholesterol metabolism in the etiology of NAFLD. The clinical significance of managing cholesterol metabolism, an option for the treatment of NAFLD, is also discussed

Nutrition Therapy for Liver Diseases Based on the Status of Nutritional Intake

The dietary intake of patients with nonalcoholic fatty liver disease (NAFLD) is generally characterized by high levels of carbohydrate, fat, and/or cholesterol, and these dietary patterns influence hepatic lipid metabolism in the patients. Therefore, careful investigation of dietary habits could lead to better nutrition therapy in NAFLD patients. The main treatment for chronic hepatitis C (CHC) is interferon-based antiviral therapy, which often causes a decrease in appetite and energy intake; hence, nutritional support is also required during therapy to prevent undernourishment, treatment interruption, and a reduction in quality of life. Moreover, addition of some nutrients that act to suppress viral proliferation is recommended. As a substitutive treatment, low-iron diet therapy, which is relatively safe and effective for preventing hepatocellular carcinoma, is also recommended for CHC patients. Some patients with liver cirrhosis (LC) have decreased dietary energy and protein intake, while the number of LC patients with overeating and obesity is increasing, indicating that the nutritional state of LC patients has a broad spectrum. Therefore, nutrition therapy for LC patients should be planned on an assessment of their complications, nutritional state, and dietary intake. Late evening snacks, branched-chain amino acids, zinc, and probiotics are considered for effective nutritional utilization

Association between Visceral Fat and Body Mass Index in Patients with Cirrhosis

Obesity has recently become a critical problem in patients with cirrhosis in Japan; however, its true prevalence and prognosis remain poorly understood. In this study, we investigated abdominal fat areas, including subcutaneous and visceral fat areas (VFA), in 49 cirrhotic patients and analyzed the association between VFA and body mass index (BMI). Fat areas were examined by computed tomography. Patients were classified as somatometric obesity and visceral obesity based on their BMI (cut-off value: 25 kg/m2) and VFA (cut-off value: 100 cm2), respectively. The mean BMI was 23.5±3.3 kg/m2 (<25 kg/m2, 35 cases; 25 kg/m2, 14 cases) and mean VFA was 108.5±118.8 cm2 (<100 cm2, 25 cases; 100 cm2, 24 cases). Thirteen out of 14 patients with BMI 25 kg/m2 had a VFA 100 cm2, and 11 of 35 patients with BMI <25 kg/m2 had a VFA 100 cm2. Thus, almost half of the cirrhotic patients in this study had visceral obesity, including a high proportion of patients with BMI <25 kg/m2. These results suggest that visceral obesity, as well as BMI, should be considered in patients with cirrhosis, and individual nutritive management regimes should be designed according to the results