Cibo e malnutrizione G. Svegliati Baroni SOS Epatopatie Croniche e Trapianto di Fegato Clinica di Gastroenterologia ed Epatologia Università Politecnica delle Marche, Ancona XIII Monotematica AISF, Pisa, 17-18 ottobre 2013
Il sottoscritto dichiara di non aver avuto negli ultimi 12 mesi conflitto d interesse in relazione a questa presentazione e che la presentazione non contiene discussione di farmaci in studio o ad uso off-label
Il paradosso dell alimentazione 925 milioni di persone denutrite, 2 miliardi malnutrite. 1 miliardo di persone in eccesso ponderale, di cui 500 milioni sono obesi. 1/3 del cibo prodotto a livello globale è perso lungo la filiera agroalimentare o sprecatoa livello domestico. Il settore agricolo consuma il 90% dell acqua disponibile a livello globale Gli allevamenti ricoprono il 30% della superficie terrestre e producono il 18% di gas a effetto serra.
Malnutrition Response of adrenal cortex Muscle protein mobilized Increase in plasma cortisol Inhibition of Growth hormones Increase in plasma amino-acids Free fatty acid increase Growth retardation Lipoprotein Synthesis Fat deposit in the liver
Odeegard & Chawla, Science 2013
Indipendent predictors of fibrosis in NAFLD and NASH AISF Expert Committee, Dig Liv Dis 2010
QUALITY? QUANTITY?
Tortosa, Diabetes Care 2007
Trichopoulou, N Engl J Med 2003
Fattori dietetici ambientali NAFLD has been induced by overfeeding of fast-food diet (Keghacias GUT 2008); Subjects with NAFLD: consume more saturated fat (Musso Hepatology 2003); consume less polyunsaturated fat (Cortez-Pinto Clin Nutr 2006); consume products with high glycemic index (Valtuena Am J Clin Nutr 2006); consume more carbohydrates (Kang Am J Gastroenterol 2006). In NASH there is a negative relationship between coffee consumption and hepatic fibrosis (Molloy Hepatology 2012)
Food-derived peroxidized fatty acids may trigger hepatic inflammation: A novel hypothesis to explain steatohepatitis Bohm et al., J Hepatol 2013
Dietary habits and their relations to insulin resistance and postprandial lipemia in NASH grassi saturi colesterolo grassi poliinsaturi Adipose tissue dysfunction, fibre including a maladaptive adipokine response to fat vitamina ingestion, C ed modulates E ( frutta liver e verdura) injury and cardiometabolic risk in NAFLD. Azione diretta sulla steatosi Modulazione TG post-prandiali e della sensibilità insulinica - post-prandiale TG e VLDL-TG - secrezione delle VLDL - sensibilità insulinica Musso et al., Hepatology 2003 and Hepatology 2012
Consumption of added sugars is decreasing in the United States 20 Guidelines 15 for adults by the American Heart Association recommend that added sugars compose less than 5% of total calories (corresponding to 2.5% of calories from % 10 fructose). Johnson et al., Circulation 2009 5 0 1999-2000 2001-2002 2003-2004 2005-2006 2007-2008 Welsh et al., Am J Clin Nutr 2011
Consuming fructose-sweetened, not glucose sweetened, beverages increases visceral adiposity and lipids and decreases insulin sensitivity in overweight/obese humans Compared to glucose: increases DNL; promotes post-prandial hypertriglyceridemia; induces hepatic and extra-hepatic insulin resistance; increases visceral adiposity. Stanhope et al., JCI 2009; Dirlewanger et al., Am J Physiol 1999; Stanhope et al., Am J Clin Nutr 2008; Maersk, et al., Am J Clin Nutr 2012.
de Wit et al., J Hepatol 2012
Increased Fructose Consumption Is Associated with Fibrosis Severity in Patients with Nonalcoholic Fatty Liver Disease Abdelmalek et al., Hepatology 2010; Kohli et al., Hepatology 2010; Charlton et al., AJP 2011; Ishimoto et al., Hepatology 2013
The Multiple Parallel Hits Hypothesis Tilg & Moschen, Hepatology 2010
Association Between Composition of the Human Gastrointestinal Microbiome and Development of Fatty Liver With Choline Deficiency De Minicis et al., submitted Hildebrandt et al., Gastroenterology 2009 Turnbaugh et al, Sci Transl Medicine 2009 Spencer et al., Gastroenterology 2011
Contribution of microflora to liver damage. High Fat Diet Gram- bacteria HCC Endotoxins- bacterial translocation Portal vein Inflammasome De Minicis et al., Hepatology 2013 LIVER
Summaryoftreatments Lifestyle advice for all patients with NAFLD; ForpatientswithNASH + T2DN Metformin/Pioglitazone For patients with NASH + hypertension A2RBs + vitamine Low threshold for statins(hcc) For patients with NASH only: best evidence forvitamine thatshouldbeconsideredas first line therapy. AGA Guidelines 2012
Estruch et al., NEJM 2013
Estruch et al., NEJM 2013
United States, $341.98/week Germany, $500.07/week Italy, $260,11/week Chad, $1.23/week