You are on page 1of 5

Nikki Finkenthal

Allie Feran
Case Study #14: Nonalcoholic Fatty Liver Disease
1. Define nonalcoholic fatty liver disease and nonalcoholic steatohepatitis.
Nonalcoholic fatty liver disease is a wide spectrum of non-alcohol related
liver diseases rnaging from fatty liver (steatosis) to non-alcoholic
steatohepatitis and cirrhosis. It relates to the accumulation of fat droplets
in the hepatocytes and can lead to various liver problems. Nonalcoholic
steatophepatitis is non alcohol related liver inflammation cause by buildup
of fat in the liver. (Nelms 2016, p. 437 and 450) (Krause 2012, p. 651).

2. What is the potential etiology(ies) of nonalcoholic fatty liver disease (NAFLD)?


Does the research indicate that there are any genetic contributions to this
condition?
Potential etiologies for the diagnosis and development of NAFLD is the
usage of drugs, inborn errors of metabolism, type 2 diabetes,
lipodystrophy, jejunal ileal bypass, obesity, dysplipidemia, insulin
resistance and malnutrition. Some genetic contributions to the
development of NAFLD are all inborn genetic based contributions.
(Krause 2012, p. 651).

3. In regard to the epidemiology of this condition, are individuals of specific


ethnicities or of either gender at higher risk for the development of NAFLD?
Individuals with an Asian ethnicity are at a higher risk of developing
NAFLD within a normal BMI range, but as the BMI increases theyre risk
also increases as well. Mr. Kim, is of Asian ethnicity and has a higher BMI
number which can relate to his development of NAFLD (Nelms 2016, p.
451).

4. How is this condition typically diagnosed? Are there common presenting signs
and symptoms for NAFLD? How might the markers of metabolic syndrome be
related to NAFLD?
Most individuals who develop NAFLD are virtually asymptomatic. Some
visible signs individuals may recognize mimick extrahepatic obstructive
jaundice with the presence of dark urine and light stools. The only other
present signs and symptoms are all clinically based. Hepatomegaly is the
most common clinical sign for the diagnosis of NAFLD. Lab tests need to
be run on the patient for proper diagnosis if abnormalities such as elevated
gamma glutamyltransferase and serum transaminases are present. Fatty
liver can be related to various metabolic disturbances such as an increase
in the mobilization of fatty acids in adipose tissue, increase in hepatic
synthesis of fatty acids, a decrease in the oxidation of fatty acids and
trapping triglycerides in the liver. (Nelms 2016, p. 451) (Krause 2012, p.
651).
5. Explain the potential role of diet in the development of NAFLD. Specifically
address the roles of simple sugars, fructose, refined carbohydrates and saturated
fat.

6. What are the long-term consequences of NAFLD if the condition progresses?


Currently two different hypothesises have been developed to explain why
some patients who develop NAFLD do or do not progress to NASH. If the
patient has insulin resistance this can lead to the potential of developing
steatosis. If the patient has progressed to NASH they can later have long-
term consequences such as chronic liver disease and cirrhosis which can
be life-threatening. 15% to 50% of NASH patients will develop cirrhosis.
The development and progression of cirrhosis in NAFLD patients is truly
dependent on their weight/ presence of obesity and if they have type 2
diabetes (Krause 2012, p. 651) (Nelms 2016, p. 451).

7. Explain the rationale for prescribing a low-carbohydrate diet in the treatment of


NAFLD.
Prescribing a low-carbohydrate diet can be implemented for treatment of
NAFLD due to the fact that it can help with controlling hyperglycemia.
The liver has a primary role in the metabolism of carbohydrates and liver
complications/ failure reduces the need for glucose production and overall
use. (Krause 2012, p. 659)

8. Describe the Mediterranean diet and how this eating pattern may support the
nutritional goals of treatment of NAFLD.
The Mediterranean diet involves the consumption of high-fats. High fat
and high MUFA based diets positively affect lipoprotein levels, serum
cholesterol levels, LDL, lipoproteins and triglycerides. All of these
laboratory levels are present as increased in Mr. Kim and other NAFLD
patients. Adopting the Mediterranean diet can help with lowering these
levels and reducing the effects of NAFLD (Krause 2012, 755).

9. Is there a role for supplementation of antioxidants in the treatment of individuals


with NAFLD?

10. Mr. Kim asks you about an article he recently read about the benefits of coffee
consumption in fatty liver disease. What recommendations might you give him?

11. Evaluate Mr. Kims weight status.


Mr. Kim has a weight of 205 lbs and height of 58 thus giving him a BMI
weight status of 31.2 kg/m2 classifying him as an obese individual.

12. Calculate Mr. Kims energy and protein requirements for weight maintenance and
for weight loss.
Adjusted body weight =
13. What other anthropometric measurements, if any may be helpful in fully assessing
Mr. Kims nutritional status and disease risk?
Mr. Kims BMI measurement can be helpful in fully assessing his
nutritional status and disease risk. He currently has a BMI of 31.2 kg/m2
classifying him as an obese individual. His body status and BMI truly
reflect his overall nutritional status. A major contributing risk factor for the
development of NAFLD is being overweight/ obese as well.

14. Identify any significant and/ or abnormal laboratory measurements for Mr. Kim.
Explain possible mechanisms for the abnormal labs.
-Elevated levels of glucose: due to dietary habits that are full of saturated,
fat, sugars and carbohydrates
-Elevated levels of cholesterol: due to poor dietary habits, a BMI of 31.2
and obese body weight
-Low levels of HDL:
-Elevated levels of VLDL:
-Elevated levels of LDL:
-Elevated LDL/ HDL ratio:
-Elevated levels of triglycerides:
-Elevated levels of HbA1c:

15. Assess Mr. Kims typical diet for total energy intake and % carbohydrate, protein
and fat. How does his estimated energy intake compare to his recommended
requirements for weight loss that you calculated in question 12? Identify the most
important factors that may impact his NAFLD.

16. How will you assess Mr. Kims physical activity level? List three questions that
you would use in your interview to support you understanding of his daily and
recreational activity?
-Does your work require moderate to vigorous intensity activity that
causes a change in breathing or heart rate for extended periods of time?
-In a typical week how often do you spend walking or engaging in low to
moderate level activities?
-How much time do you spend sitting or engaged in screen time in a
typical day?

17. Select two nutrition problems and complete the PES statements for each using the
nutrition diagnostic terminology.
-Overweight/ obese related to poor dietary choices as evidence by a BMI
of 31.1 kg/m2
-Excessive sugar and saturated fat intake related to poor dietary choices as
evidence by elevated levels of glucose, cholesterol, LDL/HDL ratio and
triglycerides in lab results
18. What culturally appropriate nutrition therapy recommendations will you make for
Mr. Kim?

19. Identify the nutrition education materials and tools you may use in your nutrition
education.
Due to the wide variety of issues that are present for Mr. Kim a general
nutrition education based class on healthy eating, cooking and basic
nutrition would be very beneficial for Mr. Kim. He currently has a very
poor diet with high contents of sugar, complex carbohydrates and
saturated fats, if he was properly educated on healthier food choices, as
well as taught how to properly cook he could dramatically change his
dietary choices and lifestyle.

20. What steps might you use to assess Mr. Kims readiness for dietary and behavior
change?

21. Are there Korean traditional health practices that you would want to address?

22. Does Mr. Kim meet the criteria for metabolic syndrome? Explain how the
nutrition interventions for NAFLD will help with the components of the
condition.
Mr. Kim meets the criteria for metabolic syndrome because he currently
possesses 3 or more of the conditions identified as risk factors. He has a
triglyceride level of 350 mg/dL, an elevated blood pressure of 142/86 and
elevated blood glucose level of 121 mg/dL. The nutrition intervention put
forth for Mr. Kim will help with the componenets of NAFLD as well as
metabolic syndrome due to the fact that all of these levels will be lowered
and hopefully reach a health and normal range. If Mr. Kim properly
follows the nutrition intervention put in place for him by his dietitians he
can lose weight, lower all of his laboratory levels and no longer have
NAFLD.

23. What topics might you want to address with Mr. Kim in follow-up nutrition
appointments?
A few topics that we would want to address with Mr. Kim in follow-up
appointments would be his new dietary choices. Making sure he reduces
his intake of sugars, carbohydrates and saturated fat will not only help him
lose weight but will also influence his laboratory results and possibly
allow him to no longer be diagnosed with NAFLD. Another topic that we
would want to address is his incorporation of physical activity into his
daily life. By implementing a physical activity plan it will help the weight
loss process and the attempt at fixing all of his abnormal and significant
laboratory results.
24. What outcomes will you monitor to evaluate the effectiveness of your nutrition
intervention?
The major outcomes that we would measure and monitor to evaluate the
effectiveness of the intervention would be dietary recall, physical activity
and laboratory results. I would suggest that Mr. Kim keeps a food log so
we could monitor his change in behavior and dietary choices and make
sure that hes chosing healthy options that will aid in his weight loss. I
would also monitor Mr. Kims physical activity by having him keep a
daily log of his activity. Lastly I would want new lab tests run on Mr. Kim
so we could see the biochemical side of things and be able to compare his
new levels of glucose, HDL, LDL, triglycerides, cholesterol and HbA1c to
his test results from the initial visit. Measuring and monitoring all of these
outcomes will tell us if the nutrition intervention and goals we put in place
for Mr. Kim would be successful.

You might also like