Essay Example in Medicine: Non-alcoholic Steatohepatitis

Non-alcoholic steatohepatitis is an inflammation that occurs due to the buildup of fat in the liver. This condition falls into the category of the fatty liver diseases as they lead to the damage of the liver cells (17). With the continuous inflammation and death of the liver cells, the accumulation of scar tissues continues which leads to the liver fibrosis. The fibrosis occurs due to the limited capacity for processing scar tissues faster than the inflammation produces (19). For this reason, non-alcoholic steatohepatitis is considered a major cause of the liver injury. The non-alcoholic steatohepatitis since it includes a wide range of clinical conditions it includes, liver cirrhosis, steatosis, and advanced cases of fibrosis (1). The consumption of alcohol is considered a major reason for liver damage but even so some non-alcoholic causes such as obesity and type 2 diabetes (20). The patients with the non-alcoholic steatohepatitis may have clinical signs which mimic the damage of the liver as that from alcohol consumption. The hepatic steatosis is the accumulation of the fat in the liver more than between 5% and 10% its total weight. Non-alcoholic steatohepatitis is considered a dangerous condition that may develop to cirrhosis in at least between 10% and 15% of the patients (1). The paper shall focus on the risk factors of the non-alcoholic steatohepatitis in people with moderate fibrosis, the complications and the treatments available.

The Risk Factors

The risk factors for patients suffering from non-alcoholic steatohepatitis with moderate fibrosis include sex, race and ethnicity, the age, genetic polymorphism, histology, and metabolic features (5 and 6).

Various studies have linked an increase in age with the risk for developing the liver fibrosis related to non-alcoholic steatohepatitis. They have also shown that men and women at their post-menopausal age are more vulnerable to developing liver fibrosis than those at the pre-menopausal. Additionally, the duration of the menopause determines the extent of the risk (2). Also, those whose their menopause stage start early are at a higher risk than those who start later on.

Race/ethnicity and diet

This is another risk factor for non-alcoholic steatohepatitis in patients with moderate liver fibrosis. For instance, in the American context, the Hispanics are at a higher risk than the Caucasian people. Surprisingly, the damage to their liver is not the same for the two ethnicities as the Caucasians reveal more cases of liver fibrosis than the Hispanics. Additionally, the Asian population may reveal a severe histological change in the condition as compared to the African-American people. These variations in the risks for developing the condition have been linked to the difference in their diets, and the propensity to accumulate body fats especially in the abdominal area which is linked to obesity and cases of overweight.

Age

Various cross-sectional studies have consistently linked an increase in age for both men and women and all races, is linked to the development of the liver fibrosis (12). Men and women who are above the age of 50 years tend to be at risk for reasons such as obesity due to the declining amount of physical exercises (2). This condition leads to the accumulation of fat in the liver in some cases that leads to the fibrosis for people with non-alcoholic steatohepatitis. This shows that the progression of the condition becomes rapid as people tend to age.

Genetic polymorphism

This is a genetic mutation where same alleles tend to appreciate along the same loci without any showing as dominant to the other (25). The rs 738409 is a nucleotide polymorphism that has been linked to the risk of developing the non-alcoholic steatohepatitis and severe cases of liver fibrosis (2). These mutant alleles are found among people in the general population, and those with them are at between 40 and 80% risk of developing the non-alcoholic steatohepatitis.

Metabolic syndrome and steatosis

These are metabolic-related issues such as obesity and diabetes. People who develop these lifestyle diseases have been associated with the risk of developing the liver fibrosis disorder (6). Studies have revealed that an increase or decrease in the body mass index beyond the normal level increases the chances of developing the disorder. For instance, people who have diabetes have issues with insulin resistance (14). This means their body cannot respond to the role that insulin induce in the effort to regulate sugar in the blood (8). For this reason, the pancreases have to work harder to generate more insulin that will increase the chances of inducing a response to the body to help control the sugar level. When this process continues for long, the pancreas fails to perform its duty and hence the sugar is oxidized and stored in parts of the body including the liver which leads to the condition (9). Additionally, high blood pressure has also been shown to have a strong correlation with the liver fibrosis. These conditions increase the chances of the occurrences of inflammations which are also associated with the non-alcoholic steatohepatitis. This is also considered a histological factor where the moderate liver damage becomes severe with time. Also in worse cases, the liver damage becomes liver cirrhosis which leads to other complications and death when the liver stops to function and not treated at the right time. Also, a condition known as hyperlipidemia, which is the presence of high fat volumes in the blood, is a risk factor for the development of the liver fibrosis. For instance, the presence of high cholesterol and triglycerides are associated with the risk of developing non-alcoholic steatohepatitis (21). The triglycerides are due to the accumulation of the lipids in cells as the body has been rendered unable to get rid of these products naturally.

Hepatitis and fibrosis

Studies have linked the hepatitis B and C infection to the development of the liver fibrosis among other end-stage complications of the liver (3). The infection makes it difficult for the liver to get rid of the excess extracellular matrix protein which induces the development of the liver problems.

Compromised immune system

The people who suffer from conditions such as the HIV/AIDS are susceptible to having their immune weakened (11). This situation makes it difficult for the body to get rid of the excess fats and other proteins that contribute to the development of the liver fibrosis (5). Additionally, patients who have had a liver transplant are sometimes prescribed drugs that help reduce the chances of the immune system rejected the foreign organ. For this reason drugs for immunosuppression are used to control this situation, which makes it impossible for the liver to perform its role. The outcome is the development of the liver problems, and in some cases, patients of the liver transplant process take at most two years before dying.

Surgery

Finally, the people who pursue surgery and treatment for obesity cases expose themselves to a rapid weight loss which is a risk factor for developing the non-alcoholic steatohepatitis. The reason for considering it a risk factor because in induced a rapid shift in the number of fatty acids and the fat in the blood which results from a rapid weight loss.

Microbiome

The human gut is home to bacteria, virus, and fungi among other microorganism, when out of balance can lead to diseases. Studies have shown the microbial metabolites can trigger inflammations and the development of hepatic steatohepatitis (26). Additionally, the gut microbiome can lead to obesity which is a major risk factor for non-alcoholic steatohepatitis for people with moderate liver fibrosis.

Fructose Corn Syrup / Coffee

The intake of high energy beverages has been linked weight gains which is a risk factor for the development of obesity. Fructose Corn Syrup / Coffee are high sugar content products, and their regular consumption leads to conversion of excess energy into fats (27). When the fat is stored in the liver, it eventually leads to liver fibrosis which is a risk factor for developing the non-alcoholic steatohepatitis.

The Treatment for the Condition.

Weight management, being overweight and obese are the major risk factors which increase the chances of occurrence of metabolic related conditions such as hypertension and diabetes (7). This situation can be controlled by establishing a program for gradual weight loss and physical exercises to attain a normal body mass index. These activities that help reduce the amount of fat accumulating in the liver which leads to the non-alcoholic steatohepatitis. Also, physical activities help to increase the muscle mass and reduces the fat volume in the body. It also improves the sensitivity of the body to the insulin which helps to control the excess sugar in the blood. The ability to metabolize the sugar using insulin reduces the risk of developing the type 2 diabetes which leads to high cases of morbidity and mortality. Also, exercise reduced the chances of developing heart problems such as the high blood pressure which is a risk factor for non-alcoholic steatohepatitis (10). This means that low fat in the liver will slow or stop the progress of the non-alcoholic steatohepatitis and hence improved health status. For instance, it may slow the progression of liver damage to cirrhosis or scare of the liver cells. For those people who are extremely obese and hence challenging to even engage in a productive physical activity, a careful surgery may be recommended, considering that surgery is also a risk factor to the non-alcoholic steatohepatitis, due to the rapid change in the blood fats ratio (23). Furthermore, an orlistat can be used to inhibit lipases and hence improve the process of weight loss. A clinical trial revealed that people relying on this methods have a chance of losing at least 10 kilograms in half a year of the treatment program (4). This treatment reduced the levels of aminotransferases which in return lowers the speeding of liver fibrosis. The side effects of using the treatment include bloating and increase in the volume of alkaline phosphatase levels which can be treated. The orlistat has been set in the USA over the counters to help people with weight problems.

However, a balanced diet is recommended for better results for the efforts made in the process of losing the excess weight. For this reason, a high protein to calorie ration is recommended to improve the chances of controlling the weight. A diet with low fat is required to ensure the excess fat in the blood do not accumulate and increases the risks further (22). Steatosis is caused by the excessive drinking of alcohol, which in return leads to the non-alcoholic steatohepatitis. For this reason, avoiding alcohol or even as part of the diet can be beneficial for patients recovering from this condition (25). Also, food with a high volume of fiber can be very reliable in the diet for people trying to lose weight. People who smoke cigarettes should abstain from the act which leads to respiratory and cardiovascular conditions.

Additionally, the use of drugs such as insulin sensitizers and other medications considered lipid lower agents are vital in the treatment of the risk factors (16). Histological and biochemical data for metformin and gemfibrozil respectively have shown to be effective in handling the condition. The drugs such as metformin-induced the b-oxidation in the mitochondria and also suppress the lipogenic enzymes. These process helps to bypass the insulin resistance and subsequently utilize the excess fatty acid in the blood for energy production (16). These activities lower the number of excess fats in and su...