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Providing perspectives on recent research into vitamins and nutritionals


Is the Liver being Affected by the Double Burden of Hidden Hunger and Overnutrition?

By Michael McBurney

Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in North America. Yesterday, I discussed the prevalence of suboptimal vitamin E status and its role in maintaining normal liver function.  With more and more people being overweight and diagnosed with type 2 diabetes, the prevalence of NAFLD is increasing.

In overweight individuals with type 2 diabetes, NAFLD is associated with more severe hyperinsulinemia, dyslipidemia, and insulin resistance (vs patients without NAFLD) but Lomonaco and colleagues did not observe any significant differences between groups in sex, body mass index, or total body fat.

Unfortunately, there aren’t any approved drug treatments for NAFLD, partially because physicians thought liver steatosis was a benign development and perceived the preferred remedy for patients with NAFLD was to lose weight, exercise more, and eat healthier diets.

What if NAFLD among the overweight is exacerbated by hidden hunger? Could essential nutrients needed to maintain healthy liver function be lacking? For example, is liver dysfunction exacerbated by suboptimal circulating α-tocopherol concentrations? Maybe.

In some people, low vitamin D status may be contributing to insulin resistance. In this case, efforts to increase serum 25(OH)D3 concentrations could support liver health. There is some evidence for increasing monounsaturated fatty acid (MUFAs) and omega-3 fatty acid and reducing saturated fat intake.

Studying the role of nutrition and disease prevention, especially with respect to the liver, is challenging. It is not easy to distinguish the effects of supplying too much fat, carbohydrate, protein and/or alcohol from too few essential nutrients – vitamins, antioxidants, omega-3 fatty acids.

The best tool to tease out the role of vitamins and omega-3s on health will be biological measures of nutritional status.

Main Citation

Lomonaco R, Bril F, Portillo-Sanchez P, Ortiz-Lopez C, Orsak B,  Biernacki D, Lo M, Suman A, Weber MH, Cusi K. Metabolic impact of nonalcoholic steatohepatitis in obese patients with type 2 diabetes. 2016 Diab Care doi: 10.2337/dc15-1876

Other Citations

Sanyal AJ, Friedman SL, McCullough AJ, Dimick-Santos. Challenges and opportunities in drug and biomarker development for nonalcoholic steatohepatitis: Findings and recommendations from an American Association for the Study of Liver Diseases – US Food and Drug Administration Joint Workshop. 2015 Hepatol doi: 10.1001/hep.27678

Ratziu V, Goodman Z, Sanyal A. Current efforts and trends in the treatment of NASH. 2015 J Hepatol doi: 10.1016.j.jhep.2015.02.041

Ruel-Bergeron JC, Stevens GA, Sugimoto JD, Roos FF, Ezzati M, Black RE, Kraemer K. Global update and trends of hidden hunger, 1995-2011: The Hidden Hunger Index. 2015 PLoSONE doi: 10.1371/journal.pone.0143497

Vos MB, Colvin R, Belt P, Molleston JP, Murray KF, Rosenthal P, Schwimmer J, Tonascia J, Unalp A, Lavine JE and the NASH CRN Research Group. 2012 J Pediatr Gastroenterol Nutr doi: 10.1097/MPG.0b013e318229da1a

Rusu E, Enache G, Jinga M, Dragut R, Nan R, Popescu H, Parpala C, Homentcovschi C, Nitescu M, Stoian M, Costach A, Posea M, Rusu F, Jinga V, Mischianu D, Radulian G. Medical nutrition in non-alcoholic fatty liver disease- a review of literature 2015 J Med Life 8(3):258-262. PMC4555902

Foroughi M, Maghsoudi Z, Askari G. The effect of vitamin D supplementation on blood sugar and different indices of insulin resistance in patients with non-alcoholic fatty liver disease (NAFLD). 2016 Iranian J Nursing Midwifery Res doi: 10.4103/1735-9066.174759