Intervención en pacientes con enfermedad por hígado graso no alcohólico (EHGNA) y síndrome metabólico a través de dieta y actividad física personalizadas y valoración de su evolución

Abstract

Non-alcoholic fatty liver disease (NAFLD) is currently the most common cause of liver disease in the western world, affecting up to 30% of the population. It has become one of the most frequent causes of chronic liver disease and altered liver function in industrialized countries and its incidence is expected to increase in the coming years, announcing itself as the main cause of liver transplantation in the near future. It is characterized by the deposition of fat in hepatocytes and it is a chronic inflammatory liver disease that encompasses a spectrum of pathologies that range from simple accumulation of fat or hepatic steatosis, to final stages of the disease such as cirrhosis, including non-alcoholic steatohepatitis and fibrosis. Its prevalence increases with age, obesity and is associated with the presence of metabolic syndrome and increased cardiovascular mortality and cancer. For all of the above, it is a relevant public health problem in western societies, whose fundamental treatment lies in changing lifestyles through diet and physical activity fundamentally . From here derives the main objective of this thesis, which is to evaluate the role of personalized intervention, both dietary and physical activity, to 20 modify fat deposits and the progression of non-alcoholic fatty liver disease in patients with obesity and metabolic syndrome; using the image and different fibrosis scores to assess the impact of said intervention on the participants. The study sample includes 155 patients, women and men between 40 and 60 years old, with overweight/obesity who present at least three of the main features of the metabolic syndrome and a diagnosis of non-alcoholic fatty liver disease by ultrasound and corroborated by magnetic resonance imaging. It is a multicenter prospective randomized clinical trial. The sample was randomized into three intervention groups; conventional diet, mediterranean diet with high frequency of meals and mediterranean diet with personalized physical activity. Six visits were scheduled for each patient, with the registration of numerous variables, and close monitoring of the participants, focusing this thesis on imaging results, anthropometry, psychological well-being, severity of the metabolic syndrome and indirect data of liver fibrosis, all from a gender perspective. The sample is very homogeneous, with no statistically significant differences observed between men and women, or menopausal and non-menopausal at baseline. They have in common a starting point of physical activity below that recommended for their age range and a very homogeneous randomization by intervention groups. The results show that, regardless of the intervention group, gender and hormonal status, all participants improve after one year in most parameters and that those who most improve their elastography results in kPa are those who have most improved fasting triglycerides, the HOMA index and the fibrosis score. And that those who have improved their fibrosis score the most after the intervention, show significant 21 improvements compared to the rest in the results of the elastography. We also observed that patients with lower metabolic syndrome severity scores have milder degrees of steatosis measured by ultrasound and elastography and that those with worse metabolic syndrome scores have worse results in ultrasound and elastography. As it is a pathology with asymptomatic presentation or a casual finding in most cases, it is important to suspect it in order to address it early. The use of different scores and non-invasive imaging techniques appear to be essential tools for the clinician, and their widespread inclusion in clinical practice seems essential for their management