Actividad física y estilo de vida en pacientes con hígado graso no alcohólico y síndrome metabólico

Abstract

Non-alcoholic fatty liver disease (NAFLD) is a pathology characterized by the accumulation of fat in the hepatocytes without alcohol abuse being the cause. Unhealthy lifestyle habits, i.e. sedentary lifestyle and poor diet, together with one or more of the abnormalities of metabolic syndrome (abdominal obesity, hypertriglyceridemia, hypertension, elevated fasting glucose and/or low high-density lipoprotein (HDL) cholesterol) are factors that are associated with the very possible development of NAFLD.. Currently, there is no pharmacological treatment for NAFLD, although it is a growing disease and its prevalence is expected to continue to increase over the years. Progression to more severe stages is not immediate, but it should be noted that NASH can progress to fibrosis, cirrhosis and even possible hepatocellular carcinoma. In addition, it is related to many other diseases such as other types of liver complications, sleep difficulties, abdominal obesity, cardiovascular diseases, type 2 diabetes mellitus and chronic renal pathology. This is why proper diagnosis and management of NASH is so important. The first strategy to apply in the management of NAFLD is lifestyle change. This is the best treatment described to date for improving both the set of diseases that constitute the metabolic syndrome and NAFLD. The recommended treatment is to practice physical activity and a healthy diet, which improves NAFLD, but also cardiovascular and metabolic health, as well as overall mortality. All the studies analyzed in this Doctoral Thesis show beneficial associations between the clinical parameters of NAFLD and metabolic syndrome when a Mediterranean diet and regular physical activity are followed. Participants with high levels of physical activity had higher energy expenditure and expended more calories than they ingested. In addition, physical activity was a risk factor for aspartate aminotransferase levels, and is a protective factor for alanine aminotransferase, gamma-glutamyl transferase (GGT) and intrahepatic fat content. Patients with higher steatosis stages, when performing physical fitness tests, presented lower sitting and standing handgrip capacity, lower values in the Chester-step test, in sleep efficiency and energy expenditure, and higher intensity of light and moderate physical activity. An intervention with diet and regular physical activity for six months improved functional fitness in middle-aged patients with NAFLD and metabolic syndrome. In addition, it also improved aerobic capacity in these individuals. Discontinuation of regular physical activity together with an unhealthy lifestyle led to worsening of metabolic syndrome and NAFLD. Confinement by COVID-19 induced a decrease in physical activity in the more active individuals, while the inactive ones increased such levels. Motivation was very important during this period of confinement. Thus, the Mediterranean lifestyle, based on adherence to a Mediterranean diet and regular physical activity, is essential to treat NAFLD and decrease metabolic syndrome. It is important to keep in mind the importance of combining both dietary and physical practices, as they have the same relevance and complement each other in combating NAFLD.