Dietary changes -- in particular limiting protein consumption -- were traditionally recommended for people with advanced liver disease, but diet modification is no longer regarded as a mainstay of liver disease management. As this shift suggests, much remains to be learned about the impact of food on liver disease progression.

George Ioannou of the Veterans Affairs Puget Sound Health Care System and colleagues sought to determine whether dietary intake is associated with the risk of hospitalization or death related to cirrhosis or liver cancer, which are often the result of chronic hepatitis B or C virus infection.

The researchers evaluated 9221 adults without evidence of cirrhosis at study entry or during the first 5 years of follow-up. Participants were subsequently followed for an average of 13.3 years as part of the first National Health and Nutrition Examination Survey (NHANES). Dietary intake was determined at baseline using a 24-hour food consumption recall questionnaire.

The investigators looked at associations between advanced liver disease outcomes and various potential risk factors and confounders, including patient sex, race/ethnicity, age, education, U.S. geographical region, body mass index, subscapular-to-triceps skinfold ratio (a measure of body fat), diabetes, and daily consumption of protein, carbohydrates, fat, tea or coffee, and alcohol.

Results

During follow-up, 123 of 9221 participants (1.3%) were diagnosed with cirrhosis (118 cases) or liver cancer (cases 5), according to hospital records or death certificates (36 were diagnosed only on the basis of death certificates).

Participants who reported a diet high in protein were at a higher risk for hospitalization or death due to cirrhosis or liver cancer (P = 0.001).

Individuals who reported a diet high in carbohydrates were at a lower risk for advanced liver disease outcomes (P = 0.003), after adjusting for potential confounders.

Although total fat consumption was not significantly associated with the risk of cirrhosis or liver cancer, cholesterol consumption was associated with higher risk (P = 0.007).

However serum cholesterol levels -- which do not always reflect dietary cholesterol consumption -- were not associated with risk of cirrhosis or liver cancer.

"Many determinants of liver disease progression are currently unknown, as evidenced by the fact that we cannot predict accurately which patients with any of the major liver diseases (hepatitis C virus, hepatitis B virus, nonalcoholic fatty liver disease, and alcoholic liver disease) will progress to cirrhosis and which ones will have a relatively benign course," theinvestigators wrote. "Our study raises the possibility that dietary factors may be important, modifiable, and hitherto unrecognized determinants of liver disease progression."

This study adds further support to a growing body of evidence linking liver disease with the metabolic syndrome, a constellation of manifestations including insulin resistance, high blood pressure, elevated blood lipids, and abdominal obesity.

Rather than severely restricting protein, most experts now recommend a balanced diet low in fat and high in fruits, vegetables, and whole grains to patients with liver disease.

Veterans Affairs Puget Sound Health Care System, Seattle, WA; University of Washington, Seattle, WA.

8/7/09

References
GN Ioannou, OB Morrow, ML Connole, and others. Association between dietary nutrient composition and the incidence of cirrhosis or liver cancer in the United States population. Hepatology 50(1): 175-184. July 2009. (Abstract).

http://www.hivandhepatitis.com/hep_c/news/2009/080709_a.html

Fast Food Likely to Accelerate Hepatitis C
By Nicole Cutler

The liver is an extraordinary organ, capable of regenerating healthy liver cells in an effort to keep it functioning optimally. There are many obvious toxins that can prevent this organ from doing its job, most notably alcohol and cigarette smoke. Most people living with a chronic liver disease such as Hepatitis C are well aware of the importance of a healthy diet, in addition to limiting or eliminating any obviously toxic substances from their lifestyle. Recent research has demonstrated that eating meals that are high in fat can have a similarly damaging affect on the liver as the consumption of alcohol.

With Hepatitis C, the liver is already damaged and weakened, thus unable to properly filter toxins from the bloodstream. Consuming a high-fat diet full of regular trips to the local fast food joint puts additional stress on this organ that it simply cannot handle. Eating a healthy diet is especially important for those living with HCV who are also overweight or lead sedentary lifestyles. This lethal combination of fast food meals with little or no physical activity is a one-two punch to the liver. Not only is weight gain inevitable, but the toxins from these greasy, fatty foods can cause your liver enzyme levels to rise dramatically, which is something most HCV patients strive to fight against.

Even though it may not be as severe as other toxins, fast food poses a serious threat to the health of your liver. Many fast food chains are now taking a more healthful approach and offering less fatty alternatives to the traditional greasy hamburger and fries. But even though the healthy salad may appear to be the better choice, beware: many of the low-fat options can still pack quite the fattening punch.

Living with Hepatitis C doesn't mean you have to give up all the things you love at once. Moderation is the key. You can still eat out and enjoy yourself, just be sure to make wise, healthy choices regarding what you put into your mouth. Your liver, and your waistline, will thank you.

This article was prepared for Hepatitis-Central.com where you'll find more than 2,750 pages of in-depth information for Hepatitis C patients and their families, caregivers and health professionals. Visit us to learn more about liver health.

Liver Damaged By Too Much Fast Food And Too Little Exercise

Written by: Peter M Crosta

A study published in the journal Gut reports that too much fast food and too little exercise can harm the liver.

Swedish researchers selected 18 thin, healthy volunteers - 12 men and 6 women - to attempt a 5 to 15% body weight increase by eating at least two fast-food-based meals per day for four weeks. The participants in this intervention group also restricted their level of physical activity to no more than 5000 daily steps. A comparison group, matched for age and sex, ate a normal diet and maintained normal exercise levels.

The study authors desired to see if doubling calorific intake and increasing total body weight had any impact on participant's liver health. Researchers checked liver enzyme and fat levels by analyzing blood samples both before the "fast-food challenge" began and at regular intervals throughout the four-week study period.

Changes in enzymes, such as alanine aminotransferase (ALT), and in hepatic triglyceride content (HTGC) were used to indicate liver damage. Abnormally high ALT levels are frequently seen in people who consume a lot of alcohol or who have been infected with the hepatitis C virus. HTGC measures fatty acid levels in the liver; too much fat in the liver leads to a condition called fatty liver disease.

At the end of the four weeks, the researchers reported:

Fast-food consumers had put on an average of 6.5 kg (14.3 lbs.)
Five participants increased their weight by 15%
One person gained 12 kg (26.4 lbs.) in two weeks
Sharp increases in ALT occurred after just one week on the fast food diet
- The average ALT level increased four-fold from 22 U/l to of 97 U/l over the 4 weeks
ALT rose to liver damage levels in 11 participants
No changes were seen in levels in the comparison group

The increases in ALT levels were linked to weight gain and increased sugar and carbohydrate intake. One subject developed fatty liver disease, and there was a large rise in liver cell fat content in the other participants.

The authors note that an increase in the fat content of liver cells is associated with insulin resistance, which in turn is associated with the metabolic syndrome. Insulin resistance syndrome is a collection of biochemical abnormalities which are linked to an increased risk of diabetes and cardiovascular disease.

Fast-food-based hyper-alimentation can induce rapid and profound elevation of serum alanine aminotransferase in healthy subjects
Stergios Kechagias, Åsa Ernersson, Olof Dahlqvist, Peter Lundberg, Torbjörn Lindström, and Fredrik H Nystrom
Gut. (2008)
doi:10.1136/gut.2007.131797
Click Here to View Article

Written by: Peter M Crosta

Love Your Liver? Skip the Fast Food

http://www.bastyrcenter.org/content/view/1389/&page=

February 28, 2008—We all know that what we eat affects our weight, cholesterol, heart health, and so on. Now new evidence suggests that your diet may also affect your liver: A study found that cutting down on fast food and excessive calories may improve liver function.

In this study, 18 people agreed to increase their weight by 5 to 15% by eating at least two fast-food meals per day, doubling their daily calories, and adopting a sedentary lifestyle for four weeks. After one week, the majority of the people developed significantly higher levels of a liver function test called alanine aminotransferase, or ALT, compared with their previous dietary habits and with a control group of people who made no changes in their diet. The fast food group also experienced increased triglyceride levels, weight gain, and increased insulin resistance.

Fredrik Nystrom, MD, PhD, the study’s lead author and a professor at the Department of Medical and Health Sciences at the University Hospital of Linkoping in Linkoping, Sweden, believes that the change in the liver test was caused by following the high-fast-food diet and increasing calories but, more specifically, from increased carbohydrate and sugar intake.

When a person has a medical checkup, the doctor often orders blood work that measures a variety of body functions including liver function. Abnormal liver function tests are not an unusual finding in a doctor’s office and there is some evidence to suggest that the prevalence of these abnormalities is increasing. Elevated levels of certain enzymes may indicate liver injury or inflammation which, if they persist for long periods of time, can lead to cirrhosis of the liver. Common causes of elevated liver enzymes are thought to be drinking too much alcohol and using certain medications.

With this new information, Nystrom and colleagues make the point that a week of overindulgent eating and being sedentary has the capacity to affect liver function. And while alcohol consumption can create a similar picture, the elevation in lab tests may not be from alcohol but rather excessive food. “We suggest that in the clinical evaluation of [people] with elevated ALT, physicians should include not only questions about alcohol intake, but also explore whether recent excessive food intake has occurred,” they concluded.

Healthy lifetsyle tips

In fact, moderate drinking has been associated with heart health and longevity, as have the other points on this list:

• Eating generous amounts of fruits (2 servings daily), vegetables (4 servings daily), whole grains (3.4 servings daily), legumes (.5 servings weekly), and fish (2.5 servings weekly)

• Drinking moderate amounts of alcohol (2.5 drinks weekly)

• Maintaining a healthy body weight

• Exercising regularly (for best results, according to one study, 40 minutes of daily walking or biking plus one hour of additional physical activity each week—but talk to your doctor before beginning a new exercise regimen)

• Not smoking

The new study suggests that “limiting sugar and carbohydrates” may be added to these tips, though more research is needed to understand which amounts and sources pose the most risk.

(Gut doi:10.1136/gut.2007.131797)

Jane Hart, MD, board-certified in internal medicine, serves in a variety of professional roles including consultant, journalist, and educator. Dr. Hart, a Clinical Instructor at Case Medical School in Cleveland, Ohio, writes extensively about health and wellness and a variety of other topics for nationally recognized organizations, Web sites, and print publications. Sought out for her expertise in the areas of integrative and preventive medicine, she is frequently quoted by national and local media. Dr. Hart is a professional lecturer for healthcare professionals, consumers, and youth and is a regular corporate speaker.