| Abstract |
In recent decades, the proportion of overweight or obese patients with chronic liver diseases has increased. Obesity constitutes a major risk factor for the complication development in cirrhosis and weight loss should be an important goal for these patients. Bariatric medicine aims at providing comprehensive care to patients with obesity and related conditions by helping them achieve and maintain a healthy weight by promoting changes in diet and lifestyle, as well as providing medical or surgical interventions when appropriate. Such an approach is the application of the Mediterranean Diet. The aim of this thesis was to systematically record the nutritional status of patients with cirrhosis in Crete, and to investigate the effects of Mediterranean Diet on such patients without subclinical hepatic encephalopathy. In addition, changes in anthropometric, hematologic, and biochemical parameters in obese patients with compensated liver cirrhosis were investigated during a four-year bariatric intervention with adherence to the Mediterranean Diet. The concurrent contribution of weight loss to all indicators was evaluated. In particular, two prospective studies have been conducted, including: The study Α involved 132 patients with cirrhosis (57.8 ± 8 years old) and 77 controls (65.4 ± 7.1 years old). The whole population followed a special 4-week dietary intake of 1,800 kcal (men) and 1,400 kcal (women) daily, based on the Mediterranean Diet. Pre- and post-intervention, serum was taken for complete biochemical and common blood tests, 24-hour urine collection, skinfold thickness, hand grip strength, anthropometric measurements (weight, height, body mass index, waist and hip circumference), whereas sera were obtained from patients with liver cirrhosis only, for measurements of CRP and IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, TNF-α, and IFN-γ. According to the results, patients with cirrhosis showed slightly more favorable changes in the somatometric parameters than healthy subjects (BMI: -1 kg/m2, body weight: -2.5 kg, waist circumference: -3.6 cm; hip circumference: -2.2 cm; body fat percentage: -1.1%; hand grip strength: 1.8 kg); women with cirrhosis showed slightly greater progress than healthy subjects of both sexes, as well as men with cirrhosis. Significant improvement was observed on almost all indices in both cirrhotic and control subjects; men with cirrhosis showing a greater decrease in triglycerides (111.3 mg/dl to 95.7 mg/dl), SGOT, γ-GT, uric acid, α-FP, urine protein, compared to healthy men, healthy women, and women with cirrhosis, with increased ferritin and Mg levels (124.095 ng/ml to 142.368 ng/ml). Women with cirrhosis showed a significant decrease in serum total cholesterol (187.2 mg/dl to 157.6 mg/dl), LDL, SGPT, ALP, HbA1c, IgA, IgM and ESR, compared to the rest, with higher HCT (38.64% to 40.25%) and Hgb values. Concurrently, glucose, SGOT, SGPT, γ-GT, total bilirubin, ALP, total cholesterol, triglycerides, LDL, uric acid, HbA1c, α-FP, IgA, IgG, IgM, ESR and INR, decreased by >54.5% in patients with cirrhosis. Corresponding values of P, Ca, Mg, Fe, ferritin, vitamin B-12, folic acid, WBC, Hgb, and HCT, showed an increase of >56.8%. After the intervention, reduction in CRP and all cytokine (IL-10, IL-2, IL-4, IL-6, IL-8, TNF-α) levels was observed in 82.6%-100% of patients with cirrhosis, except for IL-1b, which showed an increase. A notably mean decrease was observed in IL-8 (5.424 pg/ml), IL-6 (3.022 pg/ml), and TNF-α (3.663 pg/ml), whereas a significant percentage of patients with cirrhosis changed from initially abnormal, to normal post-intervention levels of IL-10, IL-6, IL-2 and IL-8, all of which were normalized. In conclusions, dietary intervention had a positive effect on all biochemical markers and hematologic indices which are directly related to liver function in both sexes of patients with cirrhosis, while CRP and all cytokine levels, except IL-1β, decreased. The study B involved 62 patients with compensated liver cirrhosis (65.87 ± 6 years old) and 44 healthy controls (59.11 ± 8 years old), with a BMI > 30 kg/m2. Both groups were subjected to a nutritional intervention based on the Mediterranean Diet, with a four-year follow-up. Anthropometric, biochemical, and hematologic parameters were evaluated at several time-points during the study and their statistical significance was assessed. According to the results, all the somatometric parameters: weight, BMI, waist and hip circumference, percentage of fat mass, and handgrip strength showed a significant improvement (p < 0.05), specifically during the first year of the intervention. Liver function tests and lipid profiles of the patients also improved (p < 0.05). This was also the case for haematological and biochemical indices such as haematocrit and ferritin, which showed a discrete improvement in the patient cohort (p < 0.05). In conclusions, a bariatric nutritional intervention based on the principles of the Mediterranean Diet along with close medical monitoring appears to have a beneficial effect on the nutritional status and the biochemical profile of obese patients with compensated cirrhosis.
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