The effects of wartime stress factors on the development and progression of non-alcoholic fatty liver disease

Abstract

Objective — to analyze the risk factors of the disease course, to evaluate metabolic factors and biochemical markers of inflammation in patients with non‑alcoholic fatty liver disease (NAFLD) who were affected by stress during martial law. Materials and methods. Examinations involved 42 patients with NAFLD who were affected by stress during military operations, and 20 subjects of the control group. Investigations included questionnaire survey, determination of the quantitative and qualitative state of visceral lipid tissue (VLT) with the use of OMRON BF‑511 body composition monitor scales. Levels of the carbohydrate and lipid metabolism indicators, markers of hepatocyte damage and systemic inflammation were determined using standard diagnostic methods. Statistical data processing was performed using the statistical program package «SPSS 17.0» (SPSS, USA). Results. A questionnaire has been developed to determine risk factors for the occurrence and progression of NAFLD during wartime. According to the results of the questionnaire survey of NAFLD patients, the influence of stress factors on the general condition of patients was revealed, in particular, 71.4% of patients experienced a decrease in mood, a feeling of anxiety and fear, excessive worry for various reasons, a feeling of tension and inability to relax (59.5%), which was accompanied by difficulties with falling asleep, restless intermittent sleep in 66.7% of cases. Patients with NAFLD demonstrated the greatest expressiveness of general weakness and rapid fatigue. In more than 2/3 of the examined patients, there was a violation of the nutrition regime, limitation of physical activity, deterioration of the quality of food and drinking water. During the war, most respondents (73.8%) experienced an exacerbation of chronic metabolic diseases. In patients with NAFLD who were under the influence of negative factors of the war period, a significant increase in the VLT levels was observed in the groups with both normal and excessive weight, and in the group with obesity (9% and 17%), which is probably due to the potential effects of the stressful wartime factors to increase the number and activity of hormonally active VLT. The significant increase in the levels of fasting glucose and markers of insulin resistance, an increase in the activity of liver transaminases and C‑reactive protein levels compared to the pre‑war period were revealed in the examined patients. Conclusions. The main epigenetic factors that could potentially affect the NAFLD course during the active military operations, were identified and evaluated. The most significant manifestations were psycho‑emotional disorders in the form of asthenic and anxiety‑depressive disorders, violations of the regime and quality of nutrition. In NAFLD patients who were affected by the negative consequences of hostilities, the significant increase in the level of fasting glucose and markers of insulin resistance was found, which is probably related to the negative effect of wartime stress factors. An increase in the activity of hepatic transaminases and the level of CRP in NAFLD patients who were affected by hostilities compared to the pre‑war period was revealed. These changes cause a more severe course of NAFLD in wartime conditions and may contribute to the rapid progression of the disease in the future.