March Summary

I chose this article because during my clinical rotations, I saw a few patients who had non-alcoholic fatty liver disease. When I saw these patients, I felt I did not know enough about the disease. Therefore, I wanted everyone to see this article in order to learn more about the disease that affects about 70 million adults in the United States. I expect more cases to arise with the obesity epidemic because excess body weight is a common factor for those with the disease. 

Question 1

This question was tricky and there isn’t a right or wrong answer. I personally thought it was a drastic decrease in calories for most participants as many of you said in the discussion. Ali, Stephanie, and Molly agree that although it would more time consuming for the researchers, they should have a baseline calorie level determined individually for each participant. Amanda stated that it is important to remember that patients with NAFLD often carry excess body weight in the form of fat and it is important to avoid “feeding the fat.” She agreed that going below 1200 calories may not be ideal for a normal/healthy individual but it is important to realize that others with certain disease states may benefit from a lower calorie range. Nate and Kevin believe that it would be too tedious to calculate individual needs with such a large sample size so the general calorie calculations are appropriate in this situation.  Kevin asked if there are any published calorie recommendations for NAFLD patients. I found in the research that there is no “blanket statement” for calorie needs for those with this disease state. Calorie needs will depend on individual weight loss goals, weight maintenance desires, and other factors including various medical conditions a patient may experience.  Michela suggested that using adjusted body weight for these patients would result in gradual healthy weight loss. Many people suggested liberalizing the calorie restriction and combining exercise into the program. I personally think this would be beneficial for patients with NAFLD. 

Question 2

Brooke made a good point that it may be too early to recommend probiotics to patients with NAFLD due to the lack of evidence about the relationship between probiotics and NAFLD.  As dietitians and future dietitians, we want to make sure we are making recommendations that are evidence based. Emily also said she would not recommend the use of probiotics unless the patient was experiencing GI irregularity. Tiffany and Emily also discussed that it is important for patients to discuss the use of probiotics with their doctors before using them. Kevin mentioned he would discuss foods such as Greek yogurt that are high in probiotics instead of recommending a supplement. Alana and many others stated that although taking a probiotics is not likely going to harm patients, but it is important to wait and see what future research suggests before making the recommendation. Joci stated that she would recommend probiotics to this population of patients because they have many health benefits for everyone. Kathy and Amy discussed the strains of probiotics found in yogurt and supplements are not created equal. I have to agree with that and I think the bottom line is to make sure whatever recommendation is made is backed up by credible evidence based research and that the doctor is also aware.

Question 3

Stephanie mentioned that she would teach her clients how to read nutrition labels and serving sizes. Molly said she would recommend the DASH diet because it is a healthy eating plan for anyone. She also stated that individual counseling style should be determined by each patient. Every patient has a different learning style. Jordan said she would use the heart healthy education materials from the nutrition care manual and set goals with the patient to encourage lifestyle change. She would also set up a follow up visit with clients to track their progress. Amanda stated she would recommend using myplate because it promotes lean protein, fiber, healthy fats, and portion control. Kathy suggested that a Mediterranean diet may be beneficial in those with NAFLD and NASH. Kelsey stated that it is important to teach patients to read food labels, how to record foods in food diaries, and how to operate the myplate website would be beneficial.  Food logs are a great way for people to become more aware of what and how much they are consuming.  I agree with Taylor’s statement that it is important to keep the initial education session simple because these patients are likely already overwhelmed with their complicated disease state. She also mentioned doing a grocery store tour with the patient to help guide them. I think this is another great suggestion if it is feasible. Angela mentioned cell phone apps for those who are technology savvy. She thinks this would be a great way to keep an activity log by allowing them to see the nutrient content of food, track their physical activity, and set/monitor their individual goals. 

Thank you for a great discussion! Everyone brought up great points and offered practical suggestions. I hope you were all able to learn something that will be useful in practice!