respectfully agree or disagree with your colleague’s assessment and explain your reasoning. In your explanation, include why their explanations make physiological sense or why they do not.
45 year-old male patient presented to the office with previous diagnosis of nonalcoholic fatty liver and metabolic syndrome. He reported feeling well. It is likely that he is not following a low carb, low-fat diet. Although, we are not given a comparison for his labs, his current lab values are all elevated.
Pt had a previous diagnosis of metabolic syndrome. His current A1C was 9.0% and fasting glucose was elevated at 170. These lab values support a diagnosis of uncontrolled diabetes mellitus.
With patient who has metabolic syndrome, the triad of elevated blood sugar, elevated blood pressure and cholesterol are present. Insulin resistance becomes More apparent. During this time the muscle tissue, adipose tissue and the liver become resistant to insulin. The uptake of glucose is impaired and delivered then we’ll start putting out new sugars despite the elevated glucose. The body is used to having elevated sugars and when these levels are not achieved through the uptake of glucose, the body must gain sugar from another source.
This excess glucose and insulin stimulation leads to an increase of triglyceride production. Over a period of time, the triglyceride production may lead to non-alcoholic fatty liver disease. The extra sugars are stored in the fat cells, mitochondrial dysfunction and inflammation will cause a rise in the liver enzymes as seen as his blood work.
Elevated blood sugars over time lead to oxidative stress and endothelial dysfunction which causes further inflammation and increase risk for cardiovascular disease.
Pts TSH level was high normal which may cause a slowing of metabolism and worsening of insulin resistance.
Metabolic syndrome and non-alcoholic fatty liver may develop from a mirage of risk factors that are both modifiable and non-modifiable. Those factors that are not able to be modified include age, sex and family history. Family history of diabetes, obesity, cardiovascular disease cannot be eliminated as factors. Behaviors that encourage diet low in carbs, low fat and a form of exercise to utilize the amount of glucose that could be stored in the muscle and increase insulin resistance. Other factors may influence insulin resistance, such as hypertension, poor sleep, chronic stress, sedentary life style. Heredity plays a large part in how our bodies respond to inflammation, systemic and hepatic.
Grander, C., Grabherr, Felix, & Tilg, Herbert (2023). Non-alcoholic fatty liver disease:
Pathophysiological concepts and treatment options. Cardiovascular Research.
