Nonalcoholic fatty liver disease is a condition defined by fat accumulation in hepatocytes not promoted by excessive alcohol consumption. It is highly prevalent and is strongly associated with ...insulin resistance, metabolic syndrome, and diabetes type II. Insulin resistance plays a crucial role in the multifactorial etiopathogenesis of this condition leading to accumulation of free fatty acids in the liver cells, thus causing lipotoxicity, inflammation, and fibrosis. In this review, we will focus on currently known pathogenesis of nonalcoholic fatty liver disease. Numerous investigation strategies are available to establish the diagnosis, from biochemical markers and ultrasound to various molecular and advanced imaging techniques and liver biopsy. Prevention is crucial. However, effective and promising therapies are strongly demanded.
Diabetic patients are predisposed to diabetic cardiomyopathy, a specific form of cardiomyopathy which is characterized by the development of myocardial fibrosis, cardiomyocyte hypertrophy, and ...apoptosis that develops independently of concomitant macrovascular and microvascular diabetic complications. Its pathophysiology is multifactorial and poorly understood and no specific therapeutic guideline has yet been established. Diabetic cardiomyopathy is a challenging diagnosis, made after excluding other potential entities, treated with different pharmacotherapeutic agents targeting various pathophysiological pathways that need yet to be unraveled. It has great clinical importance as diabetes is a disease with pandemic proportions. This review focuses on the potential mechanisms contributing to this entity, diagnostic options, as well as on potential therapeutic interventions taking in consideration their clinical feasibility and limitations in everyday practice. Besides conventional therapies, we discuss novel therapeutic possibilities that have not yet been translated into clinical practice.
Pravilna prehrana iznimno je važna u prevenciji šećerne bolesti i regulaciji glikemije. Šećerna bolest ubraja se u kategoriju bolesti koje se uspješno mogu prevenirati, dobro liječiti te im se može ...spriječiti ili odgoditi razvoj kroničnih komplikacija. Edukacija o pravilnoj prehrani treba biti individualno prilagođena, pri čemu treba obratiti pozornost na dob bolesnika, način života, socioekonomski status, tjelesnu aktivnost i komplikacije vezane uz šećernu bolest. Kod šećerne bolesti promjena životnih navika, što uključuje pravilnu prehranu, redovitu tjelesnu aktivnost i regulaciju tjelesne mase, može uvelike pridonijeti regulaciji glikemije, a u tipu 2 u nekim slučajevima može dovesti i do njene remisije. Smjernice su rezultat suradnje zdravstvenih stručnjaka koji sudjeluju u liječenju i edukaciji osoba koje boluju od šećerne bolesti. Utemeljene su na dokazima, prema metodologiji GRADE (engl. grading of recommendations, assessment, development and evaluation) koja uz snagu dokaza opisuje i razinu preporuke. Temeljni zaključci ovih smjernica odnose se na procjenu nutritivnih potreba te primjenu medicinske nutritivne terapije, individualno prilagođene osobama sa šećernom bolešću kao i onima koji imaju i neke od
vezanih komorbiditeta.
Lately there has been an increased consumption of herbal preparations, distributed as nutritional supplements, often claimed to be ‘natural’ and harmless. However, as their use is not subjected to ...strict pre-marketing testing and regulations, their ingredients are not clearly defined and there is no quality control or proof of their effectiveness and safety. A growing body of references accentuate their harmful effects, in particular hepatotoxicity, which varies from minimal hepatogram changes to fulminant hepatitis requiring liver transplantation. This case report describes liver damage that was highly suspected to originate from Herbalife® products consumption. We excluded alcohol, viral, metabolic, autoimmune and neoplastic causes of liver lesions, as well as vascular liver disease, but we noticed a connection between the use of Herbalife® products and liver damage. The exact mechanism of liver damage in our patient was not determined. After removing the Herbalife® products, liver damage resolved and there was no need to perform liver biopsy. Taking into consideration the growing consumption of herbal products and their potential harmfulness, we consider that more strict regulations of their production process and sale are necessary, including exact identification of active substances with a list of ingredients, toxicologic testing and obligatory side effect report.
U novije vrijeme bilježi se porast upotrebe biljnih pripravaka koji su važan sastojak komplementarnih i alternativnih pripravaka te su široko dostupni pod krinkom “prirodnosti” i neškodljvosti. No ...budući da njihova upotreba ne podliježe strogim predmarketinškim testiranjima i regulativama, često nemaju jasno i detaljno definiran sastav, osiguranu kontrolu kvalitete, kao niti dokaz o učinkovitosti i sigurnosti. Štoviše, sve je više literaturnih podataka koji svjedoče štetnim učincima biljnih pripravaka, a kao najčešća posljedica njihove upotrebe navodi se hepatotoksičnost s različitim stupnjevima jetrenog oštećenja, od minimalnih promjena hepatograma sve do fulminantnog hepatitisa koji zahtijeva transplantacijsko liječenje. Prikazuje se slučaj jetrenog oštećenja visoko povezanog s uporabom određenih proizvoda Herbalife®, nakon što su kao moguć uzrok jetrenog oštećenja isključeni alkohol, virusne bolesti, metabolička, vaskularna, autoimuna i neoplastična zbivanja. Točan mehanizam jetrenog oštećenja u prikazane bolesnice nismo otkrili, a budući da su se jetrena funkcija i morfologija u
potpunosti oporavile nakon ukidanja sumnjivih pripravaka Herbalife® nije bilo potrebe za biopsiju jetre. Imajući u vidu sve učestaliju
konzumaciju biljnih pripravaka s potencijalno štetnim djelovanjem, smatramo da je neophodno uvođenje kako stroge regulacije proizvodnih i prodajnih procesa, tako i točne i detaljne identifikacije aktivnih tvari na popisu sastojaka te toksikološka testiranja uz obvezu prijavljivanja nuspojava.
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