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Survey on Health Intervention for NAFLD

Author: LanLan
Tutor: XiongHongYan
School: Third Military Medical University
Course: Epidemiology
Keywords: Fatty liver Diet Fatty liver cirrhosis Breakfast Hepatic steatosis alcoholic intervention Hypertension Hyperlipidemia Liver Steatohepatitis Excessive alcohol consumption Diabetic rats Related factors Study Eating behavior Biochemical detection Case-control study High blood sugar Hyperlipidemia
CLC: R575.5
Type: Master's thesis
Year: 2010
Downloads: 156
Quote: 0
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Abstract


IntroductionFatty Liver Disease (FLD) is a clinieal pathological syndrome performed as the accumulation of fat in the liver or the fatty degeneration of the liver cells, which caused by many diseases and other factors. In clinic, it can be divided into Alcoholic fatty liver (AFLD) and Non- Alcoholic fatty liver (NAFLD). The major reasons of NAFLD are drinking, diet structure and life- style, obesity, diabetes 2 mellitus, hypertriglyceridemia, Insulinresistance (IR), hypertension and so on. So FLD, to ways of life, cannot be cured rely solely on medication, health education has become an indispensible measure.We collected the epidemiology literature published domestic on risk factors of NAFLD, and evaluated the relationship between NAFLD and the risk factors in china by means of Meta-analysis. And then we investigated the prevalence of NAFLD and related major risk factors among the staffs of our college and then given the exercise and dietary intervention by health education to evaluate the effect of health education on NAFLD.Methods1. Meta-analysisAfter collecting the epidemiology literature published domestic from 1997 to 2008 on risk factors of NAFLD were searched, which were overweight (23≤BMI<25), fat (BMI≥25), excessive drinking, smoking, high fat diet, intake of vegetables, drink green tea, exercise more, exercise less, hyperlipidemia, high HDL-Ch, low HDL-Ch, hypertension, hyperglycemia, hypercholesterolemia (≥6.5mmol/L) and diabetes, Meta-analysis was carried out using Review manager 4.2. Random effort model were applied for data processing to calculate the pooled oddsratio(OR)and its corresponding 95% confidence interval (95%CI).2. Survey of intervention experiment for NAFLD2.1 Objects170 staffs of our college were investigated with random sampling.2.2 Interview and physical examinination A face to face interview was conducted by train physician using a standardized questionnaire. Data of demography variables, alcohol drinking status, smoking status, diet structure, medica history, occupation, and behavior was collected in the questionnaire. The results of physical examination, serum lipid-profile, and ultrasonographic examination of liver which were undertaken in 2008 were also collected.2.3 intervention experimentThe patient suffering from NAFLD was directed by ultrasonographic examination of liver. Also the normal group and the NAFLD cases were randomly divided into intervention group and control group. Intervention group were signed the informed consent form, and given the healthy life style intervention and food structure intervention by health education for 6 months.2.4 evaluation of effectsAfter intervention end, each groups were given the physical examinination and the interview. Evaluate the effects of intervention by comparing the results of questionnaire and physical examinination before and after intervention.2.5 statistical treatmentAll data were processed by SPSS13.0 packages. Chi-square test was used to compare numeration data, and the measurement data were represented in Mean±SD.Results and discussion1. Meta-analysis16 epidemiological studies are selected for Meta-analysis based on our including and excluding standers. The cumulative cases and controls were 37359 and 68229, respectively. Factors which had the significant difference were as followings: fat (BMI≥25), excessive drinking, smoking, high fat diet, intake vegetables, drink green tea, exercise more, exercise less, hyperlipidemia, high HDL-Ch, low HDL-Ch, hypertension, hyperglycemia and diabetes. The pools odds ratio (OR) and 95% confidence interval were respectively as followings: 5.01 (3.23- 7.76), 3.52 (1.52- 8.15), 1.81 (1.01- 1.37), 2.82 (1.50- 5.31), 0.45 (0.37- 0.55), 0.52 (0.43- 0.64), 0.32 (0.14- 0.74), 3.49 (1.26- 9.65), 4.91 (2.69- 8.96), 0.31 (0.17- 0.57), 2.14 (1.50- 3.03), 2.19 (1.43- 3.35), 2.75 (1.66- 4.58), 2.96 (0.26- 32.98), 2.29 (1.30- 4.01). There were no significant differences between overweight (23≤BMI<25), hypercholesterolemia (≥6.5mmol/L) and NAFLD.2. Survey of intervention experiment for NAFLD2.1 The infect factor of NAFLDWe investigated the life style and physical condition of NAFLD and normal group in 2008. The logistic regression showed that the pathogenesis of NAFLD was positively correlated to drinking, not eating breakfast, fat, TG. (P≤0.05)There are 30 people had taken a change for the better, and 27 had taken a change for the worse or contracted the NAFLD. We also compared the life style and physical condition of them with others, and found: (1) Fat, not sleeping enough time, not eating breakfast, drinking can significantly increase the probability to take a change for the worse or to suffer from the NAFLD and exercise, drinking tea can significantly reduce this probability. (P≤0.05) (2) Exercise, drinking tea, intaking vegetable more than 0.5 Kg per day, intaking fruit more than 1 Kg per week and vegetarian preference can significantly increase the probability to take a change for the better in NAFLD, and not eating breakfast, drinking, salty preference, TG can reduce this probability. (P≤0.05)2.2 Effects of interventionIn the normal group which had been intervened the number of people doing exercise, intaking fruit more than 0.5 Kg per week had been increased significantly after intervention,(P≤0.05) and the number of people drinking, not intaking fruit, not eating breakfast, and often eating out had been decreased significantly.(P≤0.05) Which had no significantly changed in the untreated normal group.In the NAFLD group, the In the normal group of doing exercise, intaking fruit more than 0.5 Kg per week and 1 Kg per week, intaking vegetable more than 0.5 Kg per day, refusing eating fat, and vegetarian preference had been increased significantly,(P≤0.05) and the number of smoking, drinking, sweet preference, intaking fat more than 0.5 Kg per week, not eating breakfast, and fat had been decreased significantly in intervened people.(P≤0.05) Which had no significantly changed in the untreated people. And there were more people taken a change for the better, and less people taken a change for the worse in intervened people than untreated people. (P≤0.05) ConclusionBy meta-analysis, we found 10 Factors which can induce or aggravate NAFLD: fat (BMI≥25), excessive drinking, smoking, high fat diet, exercise less, hyperlipidemia, low HDL-Ch, hypertension, hyperglycemia and diabetes. And 4 factors which can relieve or prevent NAFLD: intake vegetables, drink green tea, exercise more, high HDL-Ch.In the staff of our school, not sleeping enough time, not eating breakfast, drinking, Exercising less, salty preference, Fat, TG is the risk factor of NAFLD, and vegetarian preference, intaking vegetables, intaking fruits, drinking tea, exercise more is the protective factor. Different in life style and habits can significantly affect the morbidity and the disease progression of NAFLD. Through acts of health education to help people change unhealthy lifestyle habits and behaviors, so that improved access to education to follow the crowd, and taken to a healthy pattern of behavior and way of life. And a short-time health education can also had a significantly affect to the disease progression of NAFLD. Suggesting that effective health education is the prevention and control of NAFLD and related diseases, one of the best means.

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CLC: > Medicine, health > Internal Medicine > Digestive and abdominal diseases > Liver and gall bladder disease > Liver metabolic disorders
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