A method for increasing the effectiveness of therapeutic interventions of non-alcoholic fatty liver disease in patients with comorbidity pathology

Abstract

The aim — to increase the efficiency of treatment and secondary prevention of non‑alcoholic fatty liver disease (NAFLD) that have patients with hypertensive illness of I — II stages 1 — 2 degrees with visceral obesity (VO) by assignment of individually developed schemes for the correction of eating behavior on the background of standard therapy of these diseases.
 Materials and methods. 140 patients (average age — 53.0 ± 0.8 years) were examined on NAFLD with VO on the background of hypertension I and II stages (100 patients with a high body mass index and 40 with normal weight) who were treated at GI «L. T. Mala National Therapy Institute of NAMS of Ukraine». All patients had medically controlled hypertension. The control group involved 40 practically healthy people, reciprocal by gender and age characteristics. The types of EB were studied using the DEBQ questionnaire, actual nutrition (AN) — with the help of the developed questionnaire and the analysis of the weekly food diary. Nutrigenetic study was conducted. Standard anthropometric measurements, body composition monitoring, ultrasound examination of the abdominal cavity and heart organs, computer tomography of the abdominal cavity and daily blood pressure monitoring were done to patients. The index of visceral obesity (IVO) and the index of the ratio of the area of visceral adipose tissue (VAT) to the area of subcutaneous abdominal adipose tissue (SAT/SAAT) were calculated. Carbohydrate, lipid metabolism, uricemia were evaluated. The patients were divided into two groups: the first group (n = 50) received NAFL in accordance with the decree of the Ministry of Health of Ukraine No 826 with an additional assignment of individually developed therapeutic diet nutrition; Group ІІ — only standard non‑medicated NAFL treatment. Duration of observation — 12 months.
 Results. Statistically significant (p < 0.05) changes in the main anthropometric indices were noted about patients of the 1st group: body weight decrease on 7 — 10 %, reduction of BMI and CW in 1.2 times (p < 0.05) and probable increase the rate of basic exchange on 16 — 20 % (p < 0.001). Correction of eating behavior leads to a possible improvement of lipid and carbohydrate metabolism, liver tests (decrease of alanine aminotransferase (ALT) in 2.4 times and aspartate aminotransferase (AST) in 2.5 times (p < 0.05)), computer tomography (CT) — signs of steatosis (increasing of X‑ray density of the liver on 35 % (p < 0.001) and visceral obesity indices (a decrease of the index of VAT in two times (p < 0.001), 2.1 times the plane of visceral adipose tissue ((p < 0.001) and 1.3 times the sagittal diameter of the body (p < 0.001)) with normalization of IVO indices in 78 % of patients and promotes the formation and adherence of the correct food habits in 86 % of patients and a decrease in the degree of dietary disorders in 14 % of patients (p < 0.001).
 Conclusions. To achieve increase of the efficiency of non‑medicated treatment of patients with NAFLD with VO on the background of hypertension of I — II stages can be by correction of violations of EB and the assignment of optimal schemes individually developed therapeutic and dietary nutrition on the basis of intragenetic study, taking into account the intragenetic features and characteristics of EB.