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Walking, strength training decrease risk of dying from liver disease, studies find


*Researchers identify 12 top foods, drinks that protects organ from damage
*Cirrhosis, liver cancer incidence higher in people with type 2 diabetes

Physical activity, including walking and muscle-strengthening activities, were associated with significantly reduced risk of cirrhosis-related death, according to research presented at Digestive Disease Week® (DDW) 2019. Chronic liver disease is increasing, partly due to the obesity epidemic, and currently there are no guidelines for the optimal type of exercise for the prevention of cirrhosis-related mortality. Researchers hope these findings will help provide specific exercise recommendations for patients at risk for cirrhosis and its complications.

“The benefit of exercise is not a new concept, but the impact of exercise on mortality from cirrhosis and from liver cancer has not yet been explored on this scale,” said Tracey Simon, MD, lead researcher on the study and instructor of medicine at Harvard Medical School and Massachusetts General Hospital, Boston. “Our findings show that both walking and strength training contribute to substantial reductions in risk of cirrhosis-related death, which is significant because we know very little about modifiable risk factors.”

Simon and her team prospectively followed 68,449 women from the Nurses’ Health Study and 48,748 men from the Health Professionals Follow-up Study, without known liver disease at baseline. Participants provided highly accurate data on physical activity, including type and intensity, every two years from 1986 through 2012, which allowed researchers to prospectively examine the association between physical activity and cirrhosis-related death.


Researchers observed that adults in the highest quintile of weekly walking activity had 73 percent lower risk for cirrhosis-related death than those in the lowest quintile. Further risk reduction was observed with combined walking and muscle-strengthening exercises.

Previous research has been limited to studies that assessed physical activity at just one point in time, or studies with very short-term follow-up. This was the first prospective study in a large U.S. population to include detailed and updated measurements of physical activity over such a prolonged period, which allowed researchers to more precisely estimate the relationship between physical activity and liver-related outcomes.

“In the U.S., mortality due to cirrhosis is increasing dramatically, with rates expected to triple by the year 2030. In the face of this alarming trend, information on modifiable risk factors that might prevent liver disease is needed,” said Dr. Simon.

“Our findings support further research to define the optimal type and intensity of physical activity to prevent adverse outcomes in patients at risk for cirrhosis.”

What foods protect the liver? The liver is responsible for breaking down carbohydrates, making glucose, and detoxing the body. It also stores nutrients and creates bile, which is necessary to digest and absorb the nutrients in food properly. There are many foods and drinks that a person can consume to help protect the liver.

Liver health is vital for overall health. Liver dysfunction can lead to liver disease, metabolic disorder, and even type 2 diabetes. While it may be impossible to manage all risk factors, consuming certain foods and drinks may help promote liver health.A report published by Medical News Today uncovered the best foods for liver health, their beneficial effects for the organ, and some foods to avoid.

Some of the best foods and drinks that are good for the liver include:
1. Coffee
Drinking coffee offers protection against fatty liver disease. A 2013 review that appears in the journal Liver International suggests that over 50 percent of people in the United States consume coffee daily.Coffee appears to be good for the liver, especially because it protects against issues such as fatty liver disease. The review also notes that daily coffee intake may help reduce the risk of chronic liver disease. It may also protect the liver from damaging conditions, such as liver cancer.

A 2014 study that appears in the Journal of Clinical Gastroenterology suggests that the protective effects of coffee are due to how it influences liver enzymes.Coffee, it reports, seems to reduce fat buildup in the liver. It also increases protective antioxidants in the liver. Compounds in coffee also help liver enzymes rid the body of cancer-causing substances.

2. Oatmeal
Consuming oatmeal is an easy way to add fibre to the diet. Fibre is an important tool for digestion, and the specific fibres in oats may be especially helpful for the liver. Oats and oatmeal are high in compounds called beta-glucans. As a 2017 study in the International Journal of Molecular Sciences reports, beta-glucans are very biologically active in the body. They help modulate the immune system and fight against inflammation, and they may be especially helpful in the fight against diabetes and obesity.

The review also notes that beta-glucans from oats appear to help reduce the amount of fat stored in the liver in mice, which could also help protect the liver. More clinical studies are necessary to confirm this, however.People looking to add oats or oatmeal to their diet should look for whole oats or steel-cut oats, rather than prepackaged oatmeal. Prepackaged oatmeal may contain fillers such as flour or sugars, which will not be as beneficial for the body.

3. Green tea
Consuming green tea may help reduce overall fat content. A 2015 study in the World Journal of Gastroenterology notes that green tea may help reduce overall fat content, fight against oxidative stress, and reduce other signs of nonalcoholic fatty liver disease (NAFLD).


It is important to note that tea may be better than extracts, as some extracts may damage the liver rather than heal it.
The study notes that there are still no specific recommendations for people with this condition to consume tea or tea extracts, but the link to liver health is promising.

4. Garlic
Adding garlic to the diet may also help stimulate the liver. A 2016 study that appears in the journal Advanced Biomedical Research notes that garlic consumption reduces body weight and fat content in people with NAFLD, with no changes to lean body mass. This is beneficial, as being overweight or obese is a contributing factor to NAFLD.

5. Berries
Many dark berries, such as blueberries, raspberries, and cranberries, contain antioxidants called polyphenols, which may help protect the liver from damage.As a study in the World Journal of Gastroenterology suggests, regularly eating berries may also help stimulate the immune system.

6. Grapes
The study that features in the World Journal of Gastroenterology reports that grapes, grape juice, and grape seeds are rich in antioxidants that may help the liver by reducing inflammation and preventing liver damage.Eating whole, seeded grapes is a simple way to add these compounds to the diet. A grape seed extract supplement may also provide antioxidants.

7. Grapefruit
The World Journal of Gastroenterology study also mentions grapefruit as a helpful food. Grapefruit contains two primary antioxidants: naringin and naringenin. These may help protect the liver from injury by reducing inflammation and protecting the liver cells.The compounds may also reduce fat buildup in the liver and increase the enzymes that burn fat. This may make grapefruit a helpful tool in the fight against NAFLD.

8. Prickly pear
The fruit and juice of the prickly pear may also be beneficial to liver health. The World Journal of Gastroenterology study suggests that compounds in the fruit may help protect the organ.Most research focuses on extracts from the fruit, however, so studies that focus on the fruit or juice itself are necessary.

9. Plant foods in general
Avocados and other plant foods contain compounds linked closely to liver health.A 2015 study that appears in the journal Evidence-based Complementary and Alternative Medicine reports that a large number of plant foods may be helpful for the liver.

These include: avocado, banana, barley, beets and beet juice, broccoli, brown rice, carrots, fig, greens such as kale and collards, lemon, papaya and watermelon.People should eat these foods as part of a whole and balanced diet.

10. Fatty fish
As a study in the World Journal of Gastroenterology points out, consuming fatty fish and fish oil supplements may help reduce the impact of conditions such as NAFLD.Fatty fish is rich in omega-3 fatty acids, which are the good fats that help reduce inflammation. These fats may be especially helpful in the liver, as they appear to prevent the buildup of excess fats and maintain enzyme levels in the liver.

The study recommends eating oily fish two or more times each week. If it is not easy to incorporate fatty fish such as herring or salmon into the diet, try taking a daily fish oil supplement.

11. Nuts
The same study says that eating nuts may be another simple way to keep the liver healthy and protect against NAFLD. Nuts generally contain unsaturated fatty acids, vitamin E, and antioxidants. These compounds may help prevent NAFLD, as well as reduce inflammation and oxidative stress.

Eating a handful of nuts, such as walnuts or almonds, each day may help maintain liver health. People should be sure not to eat too many, however, as nuts are high in calories.

12. Olive oil
Eating too much fat is not good for the liver, but some fats may help it. According to the World Journal of Gastroenterology study, adding olive oil to the diet may help reduce oxidative stress and improve liver function. This is due to the high content of unsaturated fatty acids in the oil.

Foods to avoid
In general, finding balance in the diet will keep the liver healthy. However, there are also some foods and food groups that the liver finds harder to process. These include:
*Fatty foods: These include fried foods, fast food, and takeout from many restaurants. Packaged snacks, chips, and nuts may also be surprisingly high in fats.
*Starchy foods: These include breads, pasta, and cakes or baked goods.
*Sugar: Cutting back on sugar and sugary foods such as cereals, baked goods, and candies may help reduce the stress on the liver.
*Salt: Simple ways to reduce salt intake include eating out less, avoiding canned meats or vegetables, and reducing or avoiding salted deli meats and bacon.
*Alcohol: Anyone looking to give their liver a break should consider reducing their intake of alcohol or eliminating it from the diet completely.

Meanwhile, people with type 2 diabetes should receive regular monitoring of liver function, as they could be at risk of developing life-threatening cirrhosis and liver cancer.This was one of the conclusions of a very large study of 82 million adults living in Europe.

Another finding was that for many people who develop cirrhosis and liver cancer, it seems that the conditions are already at an advanced stage at the time of diagnosis.Researchers from Queen Mary University of London and the University of Glasgow, both in the United Kingdom, led the study.

They report their results in a paper that now appears in the journal BMC Medicine.The purpose of the investigation was to estimate the risk of cirrhosis and liver cancer in people with nonalcoholic fatty liver disease (NAFLD) or steatohepatitis (NASH).

NAFLD is a major cause of liver disease worldwide. Its global prevalence has risen from 15 per cent to 25 per cent in the decade leading up to 2010 and parallels the rising tide of obesity and type 2 diabetes.For many people with NAFLD, the condition does little harm. However, some with NAFLD will go on to develop the much more aggressive form, NASH, which damages the liver and can lead to cancer.

Because people who have NAFLD or NASH are at risk of the conditions becoming life-threatening, diagnoses need to be early; that way, doctors can offer effective treatment promptly.However, senior study author Dr. William Alazawi, a reader and consultant in hepatology at Queen Mary University of London, suggests that doctors may not be picking up NAFLD early enough.

Increasing levels of the natural protein BP3 could reverse fatty liver, type 2 diabetes, and other obesity-related conditions.He and his team were surprised to find much lower rates of diagnosed NAFLD than they expected among the 82 million electronic health records that they analyzed.

This means that “many patients are actually undiagnosed in primary care,” says Dr. Alazawi.“Even over the short time frame of the study, some [people] progressed to more advanced, life-threatening stages of disease, suggesting that they are being diagnosed very late,” he adds.

According to the American Liver Foundation, NAFLD affects around 100 million people in the United States.It is normal for some fat to be present in the liver. However, when more than 5–10 per cent of the organ’s weight is fat, a state called fatty liver (steatosis) develops. NAFLD is fatty liver that is not related to alcohol consumption.NASH is a more severe form of NAFLD that swells and damages the liver and can lead to cirrhosis, liver failure, and, in some cases, cancer.

Around one in six of those with NAFLD will develop NASH, which most often develops when a person is 40–60 years old and affects women more than men. It is frequently the case that people with NASH live with the condition for years before they discover that they have it.

For their analysis, Dr. Alazawi and colleagues used electronic health records from 18,782,281 adults in Italy, the Netherlands, Spain, and the U.K.Within these, they identified 136,703 people whose records said that they had received a diagnosis of NAFLD or NASH. They then matched each with 100 controls whose records contained no such diagnosis. The match was by sex, age, location of practice, and date of visit.

The analysis showed that people with a NAFLD or NASH diagnosis were more likely to have high blood pressure, obesity, and type 2 diabetes than their matched controls.Over a median follow-up period of 3.3 years, the team noted which individuals developed liver cirrhosis and liver cancer.


The analysis revealed that compared with the controls, the risk of later receiving a diagnosis of cirrhosis was 4.73 times higher in those who had NAFLD or NASH. For a diagnosis of liver cancer, the risk was 3.51 times higher.Also, it appears that the “strongest independent predictor of a diagnosis” of cirrhosis or liver cancer was having a diagnosis of type 2 diabetes at baseline.

The analysis also showed that people with NAFLD or NASH appeared to be receiving diagnoses of more severe, life-threatening liver conditions within a few years.The researchers point out that this timescale does not reflect the much longer time that it takes for NAFLD or NASH to progress to advanced liver disease.

This would suggest, in Europe at least, that by the time that some people receive a diagnosis of NAFLD or NASH, their liver could actually be in an advanced stage of disease.“People living with diabetes are at increased risk of more advanced, life-threatening stages of [liver] disease, suggesting that we should be focusing our efforts [on] educating and preventing liver disease in [people with diabetes].”


In this article:
Chukwuma Muanya
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