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STEATOSE HEPATIQUE (FOIE GRAS), REGIME ET ACTIVITE PHYSIQUE

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Description de l'intérêt et des modalités du régime et de l'activité physique pour traiter le foie gras : stéatose (NAFLD) et stéatohépatite (NASH)

Published in: Health & Medicine
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STEATOSE HEPATIQUE (FOIE GRAS), REGIME ET ACTIVITE PHYSIQUE

  1. 1. FOIE GRAS REGIME et ACTIVITE PHYSIQUE D’après M Romero-Gomez, S Zelber-Sagi, M Trenell Treatment of NAFLD with diet, physical activity and exercise J Hepatol (2017) doi:http://dx.doi.org/10.1016/j.jhep.2017.05.016 1Claude EUGENE
  2. 2. FOIE GRAS Rappel introductif Foie gras non alcoolique (NAFLD 1 ) - Très fréquent (20-30%) - La prévalence augmente avec : 
 => âge => obésité, diabète et insulino-résistance, syndrome métabolique - Spectre histologique large : => Stéatose simple => NASH 2 : 
 associée à des degrés variables de fibrose
 le plus important facteur de progression de la fibrose - Association à des risques de :
 => Progression vers la cirrhose => Cancer du foie et autres cancers solides => Maladies cardio-vasculaires 1) Non alcoholic fatty liver disease 2) Non alcoholic steatohepatitis 2Claude EUGENE
  3. 3. FOIE GRAS Sucres ajoutés Il s’agit de sucres raffinés :sucrose, fructose Incorporés dans la nourriture et les boissons sucrées Les études épidémiologiques montrent un rapport avec la NAFLD 1 La prise quotidienne de boissons riches en fructose est associée à une fibrose plus sévère 1) Non alcoholic fatty liver disease 3Claude EUGENE
  4. 4. FOIE GRAS Types de graisses alimentaires Les acides gras polyinsaturés riches en oméga 3 Augmentent la sensibilité à l’insuline Réduisent les triglycérides hépatiques Améliorent la stéato-hépatite 4Claude EUGENE
  5. 5. FOIE GRAS Restriction calorique L’excès de poids, même modeste (3-5 kg) est un facteur de risque de NAFLD 1) La perte de poids par restriction calorique, associée ou non à une augmentation de l’activité physique => action bénéfique sur : 
 - Graisse hépatique, - Enzymes hépatiques, - Inflammation et la fibrose hépatique 1) Non alcoholic fatty liver disease 5Claude EUGENE
  6. 6. FOIE GRAS Régime Régime méditerranéen 1 a) Recommandé par les instances européennes 2 Contient 40% des calories sous forme de graisses, 
 (plus qu’un régime pauvre en graisses: maximum 30%) surtout des acides gras mono-insaturés, ou poly-insaturés riches en omega 3 Diminue les hydrates de carbone (40% des calories),
 (moins qu’un régime pauvre en graisses : 50-60% des calories) b) Réduit les risques de diabète et cardio-vasculaire 1) Huile d’olive (riche en acides gras mono-insaturés), fruits, nuts (noix, noisettes, amandes), légumes, poisson, vin avec modération et pauvre en viande rouge et sucreries. 2) EASL-EASD-EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease J Hepatol 2016;64:1388-1402. 6Claude EUGENE
  7. 7. FOIE GRAS et CANCER DU FOIE Diététique . 7Claude EUGENE Délétères Protecteurs Régime riche en cholestérol Quantité journalière de sucre (50 g/j) Poisson (AG 1 poly-insaturés riches en omega-3) Apport de 10 g de fibres Légumes Régime méditerranéen Café (cafféine et polyphénols) 1) AG : Acides gras
  8. 8. FOIE GRAS Activité physique « Triple hit behavioural phenotype » 1. Sédentarité 2. Faible activité physique 3. Mauvaise diététique 8Claude EUGENE
  9. 9. FOIE GRAS Activité physique 1 - L’activité physique diminue le risque d’insulino-résistance et de diabète - Les personnes ayant une NAFLD 2 ont moins d’activité physique que des témoins 1) Activité physique ne veut pas dire exercice physique 2) Non alcoholic fatty liver disease 9Claude EUGENE
  10. 10. FOIE GRAS Exercice physique 1 L’exercice physique, sans perte de poids
 réduit les lipides intra-hépatiques de 20 à-30% 2 1) Activité physique structurée : aérobic, contre résistance, intermittent de haute intensité 2) Alors que la perte de poids peut entraîner une réduction de la graisse hépatique > 80% 10Claude EUGENE
  11. 11. FOIE GRAS Modifications du mode de vie 
 Synthèse (1ère partie) Diminution de l’apport énergétique et augmentation de l’activité physique permettent d’obtenir une amélioration : - Biologique (ASAT/ALAT, GGT) - Métabolique (glycémie à jeun, sensibilité à l’insuline) - Hépatique (stéatose, nécro-inflammation, fibrose) 11Claude EUGENE
  12. 12. FOIE GRAS Modifications du mode de vie 
 Synthèse (2ème partie) Perte de poids soutenue de 5% => Réduction de la stéatose Amélioration des enzymes hépatiques Réduction de : triglycérides, glycémie et hémoglobine glyquée, diabète Amélioration histologique (score NAS) 12Claude EUGENE
  13. 13. FOIE GRAS Modifications du mode de vie 
 Synthèse (3ème partie) Perte de poids > 10 % 1 => Plus d’effet sur la régression de la fibrose Possible régression de la NASH 2 1) Par rapport à une perte de poids de 7 à 10% 2) Non alcoholic steatohepatitis 13Claude EUGENE
  14. 14. FOIE GRAS Modifications du mode de vie 
 Synthèse (dernière partie) Recommandations européennes 1 (surpoids / obésité) perte de poids de 7 à 10% => amélioration du bilan hépatique et de l’histologie 1) EASL-EASD-EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease
 J Hepatol 2016;64:1388-1402. 14Claude EUGENE
  15. 15. FOIE GRAS Conclusions Perte de poids = traitement efficace 1 (effet dose/réponse) Restriction calorique, régimes possibles : - Pauvre en graisses
 - Pauvre en sucres - Méditerranéen Si restriction calorique difficile :
 - Changer la composition diététique
 - Exercice physique 2 (moins efficace que la perte de poids)
 Intérêt d’une prise en charge muldisciplinaire 3 1) Perte de poids > 7% efficace sur NASH 2) Mais bénéfice cardio-vasculaire certain 3) Médecin, diététicien, psychologue, coach sportif 15Claude EUGENE
  16. 16. REFERENCES 1) M Romero-Gomez, S Zelber-Sagi, M Trenell Treatment of NAFLD with diet, physical activity and exercise J Hepatol (2017), doi: http://dx.doi.org/10.1016/j.jhep.2017.05.016 2) EASL-EASD-EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease J Hepatol 2016;64:1388-1402. 16Claude EUGENE

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