Fatty Liver w. Hep C

Hi Everyone,
For those who don't know me- my hubby is 54, Genotype 1a, Stage and Greade unknown since he was unable to have a bx cuz they couldn't get a vein for the IV (rolls eyes).
  Anyway, on his bx order I saw his dx was written as "fatty liver" and after an ultrasound the nurse on the phone reported the results as normal, with a small amount of fatty infiltration.
  I would like to know the significance of having fatty liver with Hep C. I've gotten conflicting info off the internet. Basically, I want to know how much this accelerates the fibrosis, if at all, and how important it is to cut down on fats and sweets in his diet. My hubby is very difficult about his eating- he doesn't like large meals very much, but snacks all night on  raspberry yogurt, Ritz crackers with PB and Fluff, vanilla ice cream with strawberries, bananas and whipped cream. If I did that I would weigh 500 pounds! His blood sugar is also high, but that's another story.
  If fatty liver is likely to impact his health in a major way, I must try harder to change his eating patterns. Thanks for any advice!
-Dee

[sfwandwow]

i have fatty liver and i try to not eat alot of sodium.. but some fat is okay.but really unsure about 2 much of it iam 1a also stage 2 grade 2.. and i had fatty infiltration..the best thing for both of us is to lose weight..But maybe someone else here on forumn can help u more..

[gauf]

Everything you ever wanted to know on fatty liver disease:
http://www.medicinenet.com/fatty_liver/article.htm

[jmjm530]

Yes, fatty liver is a legitimate concern. It not only can accelerate fibrosis, but also can cut down your husband's chances of a successful treatment. The good news is that it can be treated with diet, excercise and weight loss, although not everyone with fatty liver is overweight as some think. That said, your husband's diet sounds like the opposite of what someone with fatty liver should be eating. I would start from scratch -- do some research -- speak to your doctor -- and oprionally see a professional nutritionist. But first it sounds like you have to motivate your husband to take this seriously. That might be the hardest part.

-- Jim

[MrsOckert]

I just saw a Hepatologist in St Louis and the subject of NAFLD and NASH came up.

Of the population X number will develop Non-Alcoholic Fatty Liver Disease.  They don't know why some do and some don't (having the same diet).  Of X number that have NAFLD 2 - 5% of them will develop NASH, Non Alcoholic Steatohepatitis (SP?)

I've been on TX once and at this point the risks outweight the benefits of trying it again.  He told me to stop thinking about HCV.  I can't do anything about it.  However, since I have been lucky enough to be in the 5% that develop NASH, he said I can do something about that.

Start watching my diet - no more than 30 grams of fat per day and no more than 15 per meal.  1 tablespoon of peanut butter has 16 grams of fat.  1 tablespoon of butter or margarine has 11 grams of fat.  You do the math.  It doesn't take long to reach 30 grams of fat if you don't closely watch your diet.

Yes, I know peanut butter has plenty of protein.  Protein isn't the problem with a fatty liver - fat is.  No matter what form it comes in.  I'm also not supposed to eat more than  
4 oz. of meat per day.

Having a fatty liver does contribute to disease progression moving along more quickly, but it's still marked in terms of years rather than months.  He said it takes 5 - 10 years to progress from one level of damage to the next.

He's getting a second opinion on my liver biopsy - which I am completely delighted to have done.  Since my first liver doctor said "nothing I didn't expect to see" was the extent of my biopsy consult.  What a jerk.  He didn't even tell me I had NASH.  This doctor did.

[jmjm530]

MRS:  1 tablespoon of butter or margarine has 11 grams of fat.  You do the math.  It doesn't take long to reach 30 grams of fat if you don't closely watch your diet.
------------
And that's just the easy stuff to calculate. You also
For example, a chicken breast (white meat) WITHOUT skin has 6 grams of fat!

I think the reason many people fail with low fat diets is because they really aren't on a low fat diet. In order to be on one, you really have to educate yourself in terms of food choices and reading labels etc, to be able to identify both overt and hidden fats. It's not just substituting olive oil for butter or eating "healthy:" tuna salad :) BTW good fat is still fat and can still cause fatty liver if in excess.

-- Jim

[MrsOckert]

I know!!!  I took a package of chicken breasts out of the refrigerator the other day for dinner.  Now normally I would fix the chicken and give everyone one breast, but I was looking at the label and it said 2.5 grams per serving.  I thought, hmmmm that's not bad, until I looked at the servings - 7!!!  There two good sized breasts and one smaller one.  Not what my family calls 7 servings.  lol

It's a lot harder to calculate all this fat stuff than I first realized.  But I'll do what I can and not worry about the small stuff.

Glad to see you're still around.  Valorie

[MrsOckert]

I know!!!  I took a package of chicken breasts out of the refrigerator the other day for dinner.  Now normally I would fix the chicken and give everyone one breast, but I was looking at the label and it said 2.5 grams per serving.  I thought, hmmmm that's not bad, until I looked at the servings - 7!!!  There two good sized breasts and one smaller one.  Not what my family calls 7 servings.  lol

It's a lot harder to calculate all this fat stuff than I first realized.  But I'll do what I can and not worry about the small stuff.

Glad to see you're still around.  Valorie

[mikesimon]

diponectin: A New Independent Predictor of Liver Steatosis and Response to IFN-alpha Treatment in Chronic Hepatitis C.
Zografos TA, Liaskos C, Rigopoulou EI, Togousidis E, Makaritsis K, Germenis A, Dalekos GN.

Department of Medicine (Research Laboratory of Internal Medicine), Medical School, University of Thessaly, Larissa, Greece.

OBJECTIVES: To compare serum adiponectin and tumor necrosis factor (TNF)-alpha among patients with viral liver diseases; to investigate associations of serum adiponectin and TNF-alpha with histological or viral characteristics of chronic hepatitis C (CHC); to investigate adiponectin and TNF-alpha alterations during interferon (IFN)-alpha treatment; and to assess the relationship between serum adiponectin and TNF-alpha and response rates to treatment. METHODS: Adiponectin (mug/mL) and TNF-alpha (pg/mL) determinations by enzyme-linked immunosorbent assay (ELISA) in serial samples (before, the middle, the end, and 6 months after the end of treatment) from 83 CHC and 59 chronic hepatitis B (CHB) patients. Forty-three blood donors served as healthy controls. Patients were treated with IFN-alpha (4.5 MU/t.i.w.) for 12 months in CHB cases, and IFN-alpha (3 MU/t.i.w.) plus ribavirin for 6-12 months according to hepatitis C virus (HCV) genotype in CHC cases. RESULTS: After adjustment for gender and body mass index (BMI), HCV genotype 3 overweight patients (BMI > 25 kg/m(2)) had significantly lower adiponectin (7.3 +/- 2.7) at baseline compared with non-3 HCV genotype overweight patients (P < 0.05). Lower adiponectin (HCV genotype 3, P= 0.02 and HCV genotype 1, P= 0.025) and higher TNF-alpha (P= 0.025) at baseline were identified as independent predictors of liver steatosis in CHC patients. Lower adiponectin was also identified as an independent predictor of no virological response at the end of treatment (odds ratio [OR] 0.76, 95% confidence interval [CI] 0.66-0.87, P < 0.001). At the end of IFN-alpha therapy, only HCV genotype 3 patients had significantly higher serum adiponectin (10.4 +/- 6.3) compared with its levels before treatment (8.7 +/- 4.7, P < 0.05). CONCLUSIONS: This study suggests that HCV genotype 3 may directly affect adiponectin. This is further supported by the significant increase in adiponectin at the end of treatment only in HCV genotype 3 patients. Serum adiponectin at baseline appears to be an independent predictor of liver steatosis and for the achievement of end-of-treatment virological response, while serum TNF-alpha at baseline was identified as an independent predictor only of liver steatosis.

PMID: 18190648 [PubMed - as supplied by publisher]

[dlr2007]

Sfw- Thank you for youyr reply- and I hope your tx is going well. Sounds like you're doing great :)!

Gauf- Thank you for the link- I will check it out as soon as I finish replying here. I appreciate it cuz the info I found was vast and varied widely.

[dlr2007]

Mrs Ockert, sorry to hear of your dx of NASH. But it's good that you can do something about it- and sounds like you're very motivated. I hope the 2nd opinion your bx is much more encouraging.

Jmjm, thank you for your (as always) very informed reply. I realise now that I must try harder to knock some sense into hubby's extremely thick skull- lol. You're right, he really needs to take this seriously, cuz otherwise I can nag 24/7 and it'll still be the same.

It really is difficult to calculate fat sometimes, but I have some knowledge. I could definitely learn more though! Package labels can be really deceiving- you see "2.5 grams of fat per serving" then if you don't read on, miss the fact that there ae 6 servings in the package! I'm sure this is not an accident by the packaging/advertising companies.

Thanks again!

[dlr2007]

Thank you for that article- very interesting!

[jmjm530]

Labels can be deceiving, esp when it comes to fat. For example, the label may say "low fat" when in actuality it's high fact, just lower than the regular version.

Also "% of fat" can be deceiving.  If you want to actually calculate the meaningful fat percentage of a food -- unless fat calories are specified (maybe with the new regulaions they are?) -- then you have to mutliple the number of grams of fat per serving times 9 and then divide into the total number of calories per serving. So, for example, if snack "x" has 3 grams of fat per serving and each serving is 270 calories, then that serving is 10% fat  -- 270 divided by 9X3

And lastly, even if a food is low fat doesn't mean that it's good for you. It may be high calorie, it may have too high a simple sugar content in it,

Some reading:

http://www.msnbc.msn.com/id/17469445/
http://abcnews.go.com/Health/Story?id=2716049&page=1
http://babyfit.sparkpeople.com/articles.asp?id=439

[jmjm530]

To clarify the above computation -- "9" is the number of calories in a gram of fat which is approx twice as many calories as in a gram of protein or carb.

http://www.caloriesperhour.com/tutorial_gram.php