obesity

Or should we look at the causes of fatty liver?

Life-threatening liver disease is skyrocketing in Australia, with alcohol and hepatitis C and now obesity-related fatty liver disease on the rise. The average age of death of these patients is in their mid-50s. Non-alcoholic fatty liver disease (NAFLD) affects one in four Australian adults and has been increasing in parallel with the rising prevalence of obesity and diabetes in the community. It is argued that some simple measures, including regular contact with specially trained nurses, can greatly improve outcomes for this chronic condition, which sometimes is poorly understood and mismanaged by patients and their medical and nursing systems. This article comes from a press release from Flinders University, but candobetter.net has included a video about the effects of commercial quantities of fructose on the liver, from Dr Lustig, of the University of California. We spoke to Associate Professor Alan Wigg, Flinders University College of Medicine and Public Health and Head of Hepatology and the Liver Transplantation Medicine Unit, Flinders Medical Centre, who agreed that fructose has a role in the cause of fatty liver. He says that this Flinders University study is particularly looking at how to help people whose liver disease has progressed to an advanced stage.

Dr Lustig of the University of California has published numerous papers and videos about obesity and the effects on the liver of fructose. There are now many other resources online about this. We have included this information because we believe that Australians have very little information on how to prevent fatty liver, and that fructose is a major factor.

Life-threatening liver disease is skyrocketing in Australia, with alcohol and hepatitis C and now obesity-related fatty liver disease on the rise. (Refer to published detailed scientific paper accompanying this article here: Mahady_et_al-2018-Journal_of_Gastroenterology_and_Hepatology (1).pdf.)

In the past 10-15 years, the number of chronic liver failure cases at South Australia’s public hospitals has increased more than three-fold from 422 in 2001 to 1441 in 2015. Meanwhile, obesity-related liver disease is expected to become a modern epidemic by 2050.

Now Australia’s National Health and Medical Research Commission (NHMRC) has announced major funding for researchers at Flinders University and their partners at several major SA and WA public hospitals to develop a model of care to improve outcomes for these at-risk patients.

“With the average age of death of these patients in their mid-50s, this represents a huge loss for individuals, their families and for the community,” says Flinders University Associate Professor Alan Wigg, the lead investigator in the $900,000 combined partnership grant.

“The program we’re developing will aim to address the elephant in the room, that is the economic and health system cost of these patients and their devastating disease,” he says. “It will help to address the multiple and complex barriers that prevent health systems from being able implement many of the highly effective treatments that currently exist.”

Nationally, more than 6 million Australians suffer from chronic liver disease with more than 7000 deaths a year – all part of the effects of chronic conditions such as alcohol, hepatitis C, and non-alcoholic fatty liver disease (NAFLD).

A previous Deloitte study indicates the cost of managing the rising tide of chronic liver disease – including lost productivity – now exceeds $50 billion a year in Australia alone.

A previous trial by Flinders University, Flinders Medical Centre and other SA Health researchers showed that patients managed under a chronic liver failure program supervised by liver specialists within a coordinated care model had a 48% lower rate of liver-related emergency readmissions and significantly improved (67.7% versus 37.2 %, p=0.009) three-year survival than patients managed with standard care.

Not being managed in the hospital with a coordinated care model was independently associated with a 2.5-fold higher risk of mortality.

In an influential small randomised pilot trial, the research team previously demonstrated some important clinical benefits of managing this patient group with a different style of care. The “co-ordinated care model” was associated with improvement in quality of care and encouraging trends towards less emergency admissions and lower mortality.

“We argue that some simple measures, including regular contact with specially trained nurses, can greatly improve outcomes for this chronic condition, which sometimes is poorly understood and mismanaged by patients and their medical and nursing systems,” says Associate Professor Alan Wigg, an FMC gastroenterologist and researcher at the Flinders University.

The NHMRC Partnership Project maximises the impact of research funding through key collaborations that ensure rapid translation of research to the benefit of patients and health-care systems, says Flinders University Deputy Vice-Chancellor (Research) Professor Robert Saint.

“Based on previous pilot studies, expanding this research into a multicentre trial is aiming to result in fewer liver-related emergency department visits and fatalities,” Professor Saint says. “Further research on liver disease, including cirrhosis, could help patients to lead better lives and present less frequently for emergency treatment at our hospitals.”

The new project aims to reduce emergency department admissions, improve mortality rates, give patients more nursing support following discharge and more health information and better general quality of care. It is hoped that benefits will also be reduced overall cost to the health system.

Cirrhosis is a very serious and complex form of liver disease which is often not well managed, adds Associate Professor Leon Adams, from the Sir Charles Gardiner Hospital in Perth, which is one of the four Australian hospitals involved in the latest research.

“Non-alcoholic fatty liver disease (NAFLD) affects one in four Australian adults and has been increasing in parallel with the rising prevalence of obesity and diabetes in the community,” says Associate Professor Adams.

“A minority of people develop cirrhosis, however this appears increasingly common with NAFLD cirrhosis the fastest growing indication for liver transplantation in Australia and New Zealand.”

The article by Robert Bridge, quoted and linked to inside, speculates on obesity being a factor in the United States' poor performance in the PyeongChang olympic games. It includes a graph of order of obesity in OECD countries. Australia is the fifth highest obesity country. Japan is the lowest. My money is on high fructose additions to our diets, such as corn-syrup. Dr Lustig University of California San Francisco, Division of Pediatric Endocrinology, has been putting this message out for some time in fascinating scientific videos, including, "Fat Chance" and "The skinny on obesity." I have embedded "Fat chance" in the quoted material from the article inside.

Now that the Olympic torch in PyeongChang has been extinguished and the athletes and fans have gone home, the US is wrestling with its worst performance in 20 years. Could obesity rates be taking a toll on US athletic performance? On the surface, Team USA’s total haul of 23 medals, which included nine golds, seems rather respectable. It put the United States in fourth place, behind Norway, Germany and Canada. But not everyone went home satisfied, and least of all the US Olympic Committee, which had predicted US athletes would win at least 37 medals. Not only were the Americans bested by three countries which, combined, make up just one-third of the US population (Norway, which won 39 gold medals in PyeongChang, has just 5.2 million people), it was their worst performance since the 1998 Nagano Games. The situation looks even more troubling when we consider that the US fielded 242 athletes at PyeongChang, the largest-ever delegation in the history of the Winter Games.

The US has been spending wads of cash in an effort to get the most from its athletes. The amount forked over to Winter sports in the years 2015-16 increased by nearly six percent from the previous Olympic 2011-2012 cycle, AP reported. Alas, all that extra cash has produced little in way of gold. Since the 2010 Vancouver Games, America’s total medal haul in the Winter Games has been on the decline (37, 28 and 23, respectively).

“We have this amazing depth. We have these incredible medalists,” Alan Ashley, US chief of sport performance told reporters following the closing ceremony. He then ventured the question: “How do we continue to compete even at a higher level and give them what they need going forward?”

What is the source of this decline? Since it does not seem related to a lack of funding, or a shortage of potential athletes, could there be particular sociocultural reasons at play, for example particular health factors? As was already acknowledged by the US government back in 2012, when it partnered with Olympic and Paralympic athletes to get more than 1.7 million children involved in sports through Michelle Obama’s "Let's Move!" initiative, obesity is a serious issue that is only getting worse.

A recent study put out by the OECD predicts that by the year 2030, almost 50 percent of Americans will be considered as clinically obese. In 13 states, that number could actually exceed 60 percent.

While there seems to be little research to date on the subject, a 2016 policy paper put out by the American Development Model (ADM) in cooperation with the US Olympics Committee (USOC) suggests that America’s sporting officials are aware of the problem when it warned: “The percentage of obese children ages 6-11 increased from 7 percent in 1980 to 18 percent in 2010. Among children ages 12 to 19, that figure grew from 5 percent to 18 percent.” The paper goes on to detail how parents, schools and sporting clubs can alter their lifestyles and dietary choices to become better athletes.

Read more at https://www.rt.com/op-ed/420669-obesity-usa-olympics-pyeongchang/

I don’t have kids but I am disturbed about the Heart Foundation’s Active Healthy Kids very poor report card for Australian children last week. It said that Australian children are largely unfit because of a lack of exercise and that this deterioration has happened in the last couple of decades. Natasha Schranz author of the Foundation's inaugural report has graded Australian children at a disgraceful D minus. Contributing to this terrble score was a D for "active transport", meaning not nearly enough walking or bicycle riding to and from school.

Prisoners of chair and screen

81 % of Australian children do not get the required 60 minutes of physical exercise per day. 26% are not involved in organised sport, 71% are too sedentary, Discussion in the media focused on the seduction of screens such as tablets, computers television and phones. As an adult , I know how screen activities can sap the time in which one could be outside in the sunshine exercising, however there is more to this than the wonders and availability of very attractive technology.

Deprived of open space and adventure

A generation ago and before that, there was a lot more open space which enticed children outdoors when they were not in school. Incidental activity, exploring interesting places in nature or in the local neighbourhood is not just beneficial but essential to children in developing their imaginations, experiencing and dealing with unpredictable situations without rules and the directions and supervision of an adult. This used to be easy to access in the street, in vacant land, parks and the private backyard and friends backyards. There was plenty of space to explore in the suburbs.

There is a huge difference between sitting on the couch in front of a screen from 4- 6.30pm and actively playing in the local environment. It is not necessary to have a strenuous game of basketball for the body and mind to register a level of exercise and a 3 dimensional experience . Furthermore sitting is supposed be the most unhealthy thing to do for hours on end and it makes you fat! For that reason I will not make this a very long article.

Victims of blinkered planners and growth lobby

The push to make our cities more crowded by increasing the population very fast, densifying suburbs and removing private space including backyards is not going to help this terrible situation with the health of Australia’s children. It has to make it worse. Our politicians show no care at all for the welfare of Australia’s citizens. I understand that many of Melbourne’s’ private schools have built all over their playing fields and now have to bus their students to public areas to play sport. I suppose the children just sit during lunch hour because with no sports areas they could not spontaneously start a ball game.

Unnatural

It’s unnatural, anyway for children to sit all day at desks listening to teachers and severing all their avenues of expressing themselves physically adds insult to injury.

A child living in an apartment, will naturally turn to his/her tablet or phone for entertainment if the only outside alternative is a concrete balcony. A trompe l'eouil on the back wall of the 2x3 metre couryard, however far it backons cannot acccommodate the need of a child to run. We have not made Australia better over the past 50 years. The "age of entitlement is over" and for what? What really have we gained as a society?

Massive decline in children's fitness

Two generations ago, we had a nation very well represented in international sport partly because, I believe most children had a chance at participating even if it was just making a “100 in the backyard at Mum’s” or hitting a tennis ball on a broken -down asphalt court, but now it seems we have a generation of unfit young people unlikely to live as long as their parents. The social engineers and economists are always complaining about the aging population but if people start dying younger, the achievement of longer life expectancy will be just a nostalgic memory.