O efeito de programa de mudança do estilo de vida na evolução da doença hepática gordurosa não-alcoólica do obeso: ações na lipotoxicidade, lipoapoptose e nos agentes lipotrópicos hepáticos
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Data
2022-02-23
Autores
Kano, Hugo Tadashi
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Universidade Estadual Paulista (Unesp)
Resumo
A Doença Hepática Gordurosa Não-Alcoólica (DHGNA) é uma doença silenciosa e está ligada a hábitos comportamentais (sedentarismo e inadequação alimentar), culminando em desfechos patológicos, principalmente as doenças cardiovasculares (DCVs). Concomitante, a disbiose intestinal resulta em endotoxemia metabólica, o que favorece a migração de metabólitos para o fígado. Agentes lipotrópicos como colina, betaína e N-óxido-trimetilamina (TMAO) são fatores importantes na regulação do acúmulo de gordura hepática. Diante disso, a mudança do estilo de vida apresenta-se como potencial estratégia não farmacológica na modulação da DHGNA. OBJETIVO: Avaliar o efeito do programa de mudança do estilo de vida (MEV) na evolução da DHGNA e nos agentes lipotrópicos. METODOLOGIA: 567 indivíduos (79,7% mulheres) clinicamente selecionados participaram de 10 semanas da MEV "Mexa-Se Pró-Saúde" (exercício físico combinado e aconselhamento nutricional). Foram divididos em ausência (n=397) e presença (n=170) de DHGNA de acordo com o Índice de Gordura Hepática (IGH>60). Antes e após a MEV, os participantes passaram por avaliações: socioeconômica, clínica, composição corporal, dietética, coleta sanguínea e análises laboratoriais. As análises estatísticas foram realizadas pelo software STATISTICA ver.12.0, adotando p<0,05. RESULTADOS: No momento inicial, 30,0% apresentaram DHGNA a qual foi acompanhada de menor aptidão cardiorrespiratória, maior adiposidade, estresse oxidativo-inflamatório, resistência insulínica, elevação das aminotransferases e de dislipidemia. Após a MEV, portadores de DHGNA apresentaram maiores reduções de triacilglicerol (TG) e aminotransferases. Dez semanas da MEV aumentaram a capacidade antioxidante e reduziram TMAO, a endotoxemia metabólica, o estresse oxidativo-inflamatório e a resistência insulínica, explicando 76,0% da variação ocorrida no IGH e, consequentemente, reduzindo 27,0% da DHGNA. CONCLUSÃO: a MEV "Mexa-Se Pró-Saúde" foi estratégia terapêutica não farmacológica na melhora da DHGNA, tendo na redução do TG e da LBP, aumento do glutationa total, e redução do TMAO e do risco de DCVs como principais indicadores desta resposta.
Non-Alcoholic Fatty Liver Disease (NAFLD) is a silent disease and is linked to behavioral habits (sedentary lifestyle and poor eating habits), resulting in pathological outcomes, mainly such as cardiovascular diseases. Concomitantly, dysbiosis results in metabolic endotoxemia, which favors the migration of metabolites to the liver. Lipotropic agents such as choline, betaine, and Trimethylamine N-oxide (TMAO) are important factors in regulating hepatic fat accumulation. Therefore, lifestyle change presents itself as a potential non-pharmacological strategy in NAFLD modulation. PURPOSE: To evaluate the effect of the lifestyle change program (LSMP) on the evolution of NAFLD and lipotropic agents. METHODS: 567 individuals clinically selected (79.7% women) participated in 10 weeks of the LSMP "Mexa-Se Pró-Saúde" (combined physical exercise and nutritional counseling). They were divided into absence (n = 397) and presence (n = 170) of NAFLD according to the Fatty Liver Index (FLI > 60). Before and after the LSMP, participants underwent assessments: socioeconomic, clinical, body composition, diet, blood collection and laboratory analysis. Statistical analyzes were performed using STATISTICA software ver.12.0, adopting p <0.05. RESULTS: At baseline, 30.0% had NAFLD, which was accompanied by lower cardiorespiratory fitness, higher adiposity, oxidative-inflammatory stress, insulin resistance, elevation of aminotransferase levels and dyslipidemia. After LSMP, NAFLD carriers showed greater reductions in triglycerides (TG) and aminotransferase levels. Ten weeks of LSMP increased antioxidant capacity and reduced TMAO concentrations, reduced metabolic endotoxemia, oxidative-inflammatory stress and insulin resistance, explaining 76.0% of the variation in FLI and, consequently, reducing 27.0% of NAFLD. CONCLUSION: the LSMP "Mexa-Se Pró-Saúde" was an effective non-pharmacology therapeutic strategy to improve NAFLD, with the reduction of TG and LBP, increase of total glutathione, and reduction of TMAO and risk for cardiovascular risk as the main indicators of this response.
Non-Alcoholic Fatty Liver Disease (NAFLD) is a silent disease and is linked to behavioral habits (sedentary lifestyle and poor eating habits), resulting in pathological outcomes, mainly such as cardiovascular diseases. Concomitantly, dysbiosis results in metabolic endotoxemia, which favors the migration of metabolites to the liver. Lipotropic agents such as choline, betaine, and Trimethylamine N-oxide (TMAO) are important factors in regulating hepatic fat accumulation. Therefore, lifestyle change presents itself as a potential non-pharmacological strategy in NAFLD modulation. PURPOSE: To evaluate the effect of the lifestyle change program (LSMP) on the evolution of NAFLD and lipotropic agents. METHODS: 567 individuals clinically selected (79.7% women) participated in 10 weeks of the LSMP "Mexa-Se Pró-Saúde" (combined physical exercise and nutritional counseling). They were divided into absence (n = 397) and presence (n = 170) of NAFLD according to the Fatty Liver Index (FLI > 60). Before and after the LSMP, participants underwent assessments: socioeconomic, clinical, body composition, diet, blood collection and laboratory analysis. Statistical analyzes were performed using STATISTICA software ver.12.0, adopting p <0.05. RESULTS: At baseline, 30.0% had NAFLD, which was accompanied by lower cardiorespiratory fitness, higher adiposity, oxidative-inflammatory stress, insulin resistance, elevation of aminotransferase levels and dyslipidemia. After LSMP, NAFLD carriers showed greater reductions in triglycerides (TG) and aminotransferase levels. Ten weeks of LSMP increased antioxidant capacity and reduced TMAO concentrations, reduced metabolic endotoxemia, oxidative-inflammatory stress and insulin resistance, explaining 76.0% of the variation in FLI and, consequently, reducing 27.0% of NAFLD. CONCLUSION: the LSMP "Mexa-Se Pró-Saúde" was an effective non-pharmacology therapeutic strategy to improve NAFLD, with the reduction of TG and LBP, increase of total glutathione, and reduction of TMAO and risk for cardiovascular risk as the main indicators of this response.
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Agentes lipotrópicos, Doença hepática gordurosa não-alcoólica, Estilo de vida sedentário, Mudança do estilo de vida, Risco cardiovascular, Fígado - Doenças, Fatores de risco de doenças cardiacas, Lipotrópicos