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Fatty liver
Non-alcoholic fatty liver disease (NAFLD) : simple deposition of adipose tissue in the liver.
1. Incidence of NAFLD: 20%-30% in Western countries and 5%-18% in Asia
2. NAFLD was 10% higher in overweight individuals compared to lean persons
3. Will be the major cause of liver related morbidity and mortality as well as a leading indication for liver transplantation
4. Highest risk: Hispanic population; Increasing risk: Asian population
5. Independent risk factor: Diet, cigarette smoking, sedentary behavior
6. Workup: rule out alcoholic, viral, medication use, parenteral nutrition, Wilson’s disease, biliary disease, autoimmune hepatitis, and malnutrition.
7. Treatment: early diagnosis is the KEY. Weight reduction, Diet modification, Exercise.
Non-alcoholic fatty liver (NAFL)
Steatosis of the liver, involving greater than 5% of parenchyma, with no evidence of hepatocyte injury
Mild: 5%-33%
Moderate: 34%-66%
Severe: > 66%
Non-alcoholic steatohepatitis (NASH)
Liver cells become injured in a background of steatosis
Diabetes
Standard Care
1. Diabetes is a worldwide epidemic (415 million in 2015), causing 5 million death in 2015
2. 90% of DM are type 2 DM. Up to 50% of T2D remain undiagnosed, Some T2D patients already have kidney, eye or neurology complications when diagnosed.
3. Many T2DM cases can be prevented by adopting a healthy lifestyle. High-risk factors are age > 45, obesity, increased wairst circumference, hypertension and family history of DM.
4. Lifestyle change: reduce the carbohydrate (calerie intake cut by 600 kcal), avoid snacks and sweets, reduce the frequency of eating out, increase physical activity (>150 min per week), weight reduction (>5-7%).
5. Self-monitoring of blood glucose at home
6. HbA1c check every 3 month, generally targeting <7%, and avoid hypoglycemia (glucose < 70mg/dl)
7. Keep LDL low, targeting < 70 mg/dl if age between 40 and 75 years
Foot check
1. Monofilament test
2. Podiatry follow up yearly for neuropathy prevention
Hypertension
1. Maintain a healthy weight, weight loss is a priority
2. Low sodium diet, < 2.4g sodium per day
3. Maintain adequate dietary potassium from fresh fruits and vegetables
4. Exercise, 30 min a day, 5 days a week
5. Limit daily alcohol intake (2 drinks for male per day, and 1 drink for female)
6. Stop smoking and reduce the intake of dietary saturated fat
7. Home monitor, check BP daily till stabilized especially in winter
8. Better taking the pill in the evening than in the morning
Vitamin D defficiency
1. About 1.3 million osteoporosis-related fractures occur every year in the US
2. Annual check for serum 25-hydroxyvitamin D (recommend range 20 - 40 ng/mL (50 to 100 nmol/L))
3. Vitamin D insufficiency <20ng/mL; Vitamin D deficiency <12ng/mL. Experts agree that levels lower than 20 ng/mL are suboptimal for skeletal health. 30 ng/mL is necessary for the elderly to prevent falls and fractures
4. Risk factors: Age, Dark skinned, Limited sun exposure, Obese, Malabsorption, Phenytoin intake, Hospitalized
5. Food to choose: Milk, Cheese, Yogurt, Salmon,Tuna, Saldine, Liver, Mushroom, etc
6. Vitamin D supplementation may have some protection for acute URI, especially in those with Vit D deficiency
7. Supplimentation: Vitamin D2 is cheaper, but Vitamin D3 is better. Severe cases needs to start with bolus and followed with maintenance dose. Malabosorption needs to be considered if not responding well to appropriate supplemention
Gout
1. Low-fat dairy and reduced meat and seafood intake
2. Protein intake from soy and legumes was associated with reduced risk
3. Avoidance of sugar-sweetened beverages
4. Fresh cherry fruit once or twice daily
5. Reduction in alcohol intake, Better wine than beer or liquor
6. Weight reduction if you are overweight or obese
7. For hypertension patients, recommend losartan, avoid diuretics
8. Allopurinol to lower the uric acid (goal < 6 mg/dL )
9. Colchicine to reduce the frequency of recurrent gout flares
Fall
1. check the vision
2. check the balance
3. check the sensation of the feet
4. check the home settings for risks for fall
Kidney stone
1. Adequate hydration every day
2. Diet improvement, reduce consumption of spinach, tomato, chocolate, peanut, etc
3. High Calcium diet to reduce the absorption of oxalate
4. Low sodium diet
5. Avoid too much supplement of vitamin C
6. Reduce sugar intake
GERD (acid reflex)
1. Sleep at least 2-3 hours later after eating
2. Avoid food: coke, chocolate, coffee, orange, peppermint, tomato, fatty food
3. Quit drinking and smoking
4. Weight loss
hyperlipidemia
Weight Management is the key!
1. LDL is bad cholesterol, HDL is good cholesterol.
Diet:
Exercise:
Weight loss:
Do I need medication for treatment?