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Liver is the main organ that carries out various functions such as detoxification, nutrition metabolism, protein synthesis, glycogen storage. These functions get disturbed due to various chronic liver diseases. Liver disease accounts for approximately 2 million deaths per year worldwide1. Chronic liver diseases could arise due to various risk factors including infections, autoimmune conditions, inheritance, harmful use of alcohol, obesity, insulin resistance and metabolic syndrome. Among the different types of liver diseases, both alcoholic liver disease (ALD) and non-alcoholic fatty liver disease (NAFLD) could be adequately prevented and managed through lifestyle changes as part of medical nutrition therapy.
Irrespective of the type of liver disease, the liver damage progresses in the same four stages:
In a recent study by Varol and coworkers, it was found that intensive lifestyle interventions and medical nutrition therapy are effective in attaining 5% body weight loss and NAFLD remission in both lean as well as obese patients3.
Interventions promoting weight loss are necessary for patients with non-alcoholic fatty liver disease as such persons with obesity consume high amounts of calories and other nutrients when compared to healthy individuals4.
Obese and severely obese had a 1.6 and 1.9 times higher risk of transplantation or death from acute liver failure (ALF). Obese patients had 3.4 times higher risk of dying after transplantation5.
A study was conducted to evaluate dietary modifications as a form of treatment in NAFLD. It was assessed that 31 subjects who adhered to diet protocols of reduced-calorie and fat intake for a period of 6 months had a greater reduction in baseline weight of 5%, BMI, waist circumference, ALT and GGT values, hepatic, visceral fat, and HOMA IR index6.
In another randomized trial conducted by Zivkovic et al with 12 non-diabetic persons with biopsy-confirmed NAFLD, the effect of the Mediterranean diet on insulin resistance and hepatic steatosis was evaluated. After 18 weeks of follow up though there was no change in weight loss while there was a decrease in hepatic steatosis and improved insulin sensitivity7.
In a clinical trial conducted by Capanni et al, it was found that prolonged supplementation of omega 3 fatty acids for a period of 12 months in non-alcoholic fatty liver disease patients improved liver function to some extent during a biochemical evaluation8.
In a double-blind controlled study conducted by Marchesini et al, it was found that long-term supplementation with oral branched-chain amino acids is useful to prevent individuals from progressing into liver failure9.
Synbiotics which are a combination of prebiotics and probiotics are very helpful in reducing the liver enzymes and other biomarkers. In a randomized, double-blind, placebo-controlled clinical trial of 52 patients with non-alcoholic fatty liver disease were advised to take synbiotics and a placebo capsule twice daily along with lifestyle modification for a period of 28 weeks. During the evaluation, it was found that there was a great reduction in the levels of liver enzymes (ALT, AST, GGT), C-Reactive Protein, and inflammatory cytokines compared to that of the placebo group10.
The following are the tests done to determine the severity of liver disease. A liver panel is a group of tests that are performed together to detect, evaluate, and monitor liver disease or damage.
Reference Range For Liver Panel11,12,13
|ALT||7 to 55 units per liter (U/L)|
|AST||8 to 48 U/L|
|ALP||40 to 129 U/L|
|Albumin||3.5 to 5.0 grams per deciliter (g/dL)|
|Total protein||6.3 to 7.9 g/dL|
|Bilirubin||0.1 to 1.2 milligrams per deciliter (mg/dL)|
|GGT||8 to 61 U/L|
|LD||122 to 222 U/L|
|PT||9.4 to 12.5 seconds|
Asrani SK, Devarbhavi H, Eaton J, Kamath PS.. J Hepatol. 2019 Jan;70(1):151-171. Burden of liver diseases in the world
Hamurcu Varol P, Kaya E, Alphan E, Yilmaz Y. Role of intensive dietary and lifestyle interventions in... : European Journal of Gastroenterology & Hepatology. Eur J Gastroenterol Hepatol. 2020 Oct;32(10):1352-1357.
A. R. Moschen and H. Tilg, “Nutrition in pathophysiology and treatment of nonalcoholic fatty liver disease,” Current Opinion in Clinical Nutrition and Metabolic Care, vol. 11, no. 5, pp. 620–625, 2008.
Canbay A, Chen SY, Gieseler RK, Malago M, Karliova M, Gerken G, et al.Overweight patients are more susceptible for acute liver failure Hepatogastroenterology 2005; 52(65):151.
M. C. Elias, E. R. Parise, L. D. Carvalho, D. Szejnfeld, and J. P. Netto, Nutrition and Physical Activity in Nonalcoholic Fatty Liver Disease” Nutrition, vol. 26, no. 11-12, pp. 1094–1099, 2010.
A. M. Zivkovic, J. B. German, and A. J. Sanyal, Comparative review of diets for the metabolic syndrome: implications for nonalcoholic fatty liver disease” The American Journal of Clinical Nutrition, vol. 86, no. 2, pp. 285–300, 2007.
M. Capanni, F. Calella, M. R. Biagini et al., “Prolonged n-3 polyunsaturated fatty acid supplementation ameliorates hepatic steatosis in patients with non-alcoholic fatty liver disease: a pilot study,” Alimentary Pharmacology and Therapeutics, vol. 23, no.8, pp. 1143–1151, 2006.
G. Marchesini, G. Bianchi, M. Merli et al., .Nutritional supplementation with branched-chain amino acids in advanced cirrhosis: a double-blind, randomized trialGastroenterology, vol. 124, no. 7, pp. 1792–1801, 2003
Tannaz Eslamparast, Hossein Poustchi, Farhad Zamani, Maryam Sharafkhah, Reza Malekzadeh, Azita Hekmatdoost, Synbiotic supplementation in nonalcoholic fatty liver disease: a randomized, double-blind, placebo-controlled pilot study, The American Journal of Clinical Nutrition, Volume 99, Issue 3, March 2014, Pages 535–542
Smith et al, Lab tests online; American Association for Clinical Chemistry (AACC)2001-2020.
Wintrobe's Clinical Hematology. 14th ed. Greer J, editor. Philadelphia, PA: Wolters Kluwer: 2019.
Henry's Clinical Diagnosis and Management by Laboratory Methods. 22nd ed. McPherson R, Pincus M, eds. Philadelphia, PA: Elsevier Saunders; 2011.