He momona nō hoʻi kou akepaʻa? E aʻo kākou e pili ana i ka MASH (Metabolic Dysfunction-Associated Steatohepatitis)!

Ua lohe paha ʻoe i kahi maʻi e hōʻiliʻili ai ka momona i loko o ke akepaʻa? I kekahi manawa, hiki i kēia ʻano ke lilo i mea koʻikoʻi me ka ʻole o nā hōʻailona nui. I kēia lā, e kamaʻilio mākou e pili ana i kekahi maʻi e hiki ke hoʻopilikia malū i ko mākou akepaʻa. Ua kapa ʻia kēia ʻo MASH (Metabolic Dysfunction-Associated Steatohepatitis).

He aha ka MASH (Metabolic Dysfunction-Associated Steatohepatitis)?

I ka ʻōlelo maʻalahi, ʻo MASH kahi kūlana kahi i nui loa ai ka momona o kou akepaʻa, e hoʻoulu ai i ka mumū , kahi kūlana e like me kahi ʻeha. E noʻonoʻo i kēia ʻano: ke loaʻa iā ʻoe kahi ʻeha, lilo ka ʻāpana i ʻulaʻula, pehu, a wela, a hana like ka mea i loko o ke akepaʻa. ʻO ka inoa no kēia kūlana ʻo NASH (non-alcoholic steatohepatitis).

ʻO kēia kūlana, i kapa ʻia ʻo MASH, he ʻāpana ia o kahi hui ākea o nā maʻi akepaʻa i kapa ʻia ʻo MASLD (Metabolic Dysfunction-Associated Steatotic Liver Disease). Hoʻokumu ʻia kēia e ka hōʻiliʻili ʻana o ka momona i loko o ke akepaʻa no nā kumu ʻē aʻe ma mua o ka hoʻohana ʻana i ka waiʻona.

ʻO ka mea nui loa, inā ʻaʻole mālama pono ʻia kēia, i ka hala ʻana o ka manawa hiki ke alakaʻi i nā maʻi e like me ka cirrhosis, ka mea e lilo ai ke akepaʻa i paʻakikī a ʻeha, a i ʻole nā ​​​​maʻi weliweli e like me ke kanesa o ke ake. No laila, he mea nui loa ka makaʻala i kēia.

He aha nā kumu maʻamau o MASH? ʻO wai ka mea i pilikia?

ʻO ke kumu nui o MASH ka hōʻiliʻili nui ʻana o ka momona i loko o ke akepaʻa, kahi e hōʻino ai i ke akepaʻa a hoʻoulu i ka mumū. Hiki ke loaʻa kēia ʻano ke loaʻa nā pilikia me ka metabolism o ke kō a me ka momona i loko o ko mākou kino. E nānā kākou i nā kumu nui a me nā mea pilikia e hoʻopilikia ai i kēia:

• Momona a kaumaha paha: He kumu nui kēia.
• ʻO ka maʻi diabetes ʻano 2: ʻO ka poʻe me ka maʻi diabetes he nui ka pilikia o ka loaʻa ʻana o MASH.
• Kolesterol kiʻekiʻe: Hoʻonui ʻia ka nui o ka cholesterol maikaʻi ʻole i loko o ke koko.
• Nā triglycerides kiʻekiʻe: He ʻano momona kēia i loko o ke koko. ʻAʻole maikaʻi hoʻi ka hoʻonui ʻia o kēia mau mea.
• Ke koko kiʻekiʻe: Kāhea mākou ia he kaomi.
• Ke kū'ē ʻana o ka insulin: Ke pane pono ʻole nā ​​​​​​kelepona o ke kino i ka insulin. He kūlana kēia ma mua o ka maʻi diabetes.

E hoʻomanaʻo, i kekahi manawa ʻoiai inā he kaumaha maʻamau kou, inā he cholesterol kiʻekiʻe kou, ke koko kiʻekiʻe, a i ʻole nā ​​​​maʻi e like me ka maʻi diabetes, aia paha ʻoe i kekahi pilikia o ka loaʻa ʻana o ka MASH. No laila, inā loaʻa iā ʻoe kekahi o kēia mau mea pilikia, he mea naʻauao ke ʻike i kāu kauka a nānā ʻia no ka MASH.

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He aha nā hōʻailona o MASH? Pehea ʻoe e ʻike ai?

Eia ka pilikia: ʻAʻole hōʻike pinepine ʻo MASH i nā hōʻailona maopopo i nā pae mua.Hoʻomaka mālie ka maʻi i nā makahiki he nui. Hoʻomaka wale kekahi mau hōʻailona e ʻike ʻia ma hope o ka hōʻino nui ʻia ʻana o ke akepaʻa. Ke ʻike ʻia nā hōʻailona, ​​​​hiki ke komo pū me:

• Luhi: Manaʻo luhi ʻoiai me ka hana ʻole ʻana i kekahi mea.
• ʻO ka ʻeha a i ʻole ka ʻeha ma kou ʻōpū ʻākau luna: Ma kahi o ke akepaʻa.
• Ka pohō kaumaha i wehewehe ʻole ʻia.
• Ka nāwaliwali o nā ʻiʻo a i ʻole ka nalowale ʻana o nā ʻiʻo.
• ʻŌpū a i ʻole nā ​​wāwae pehu.
• Ke koʻikoʻi ke kūlana, melemele o nā maka a me ka ʻili (jaundice): ʻO kēia ka mea a mākou e kapa nei he jaundice.

ʻOiai ʻaʻohe hōʻailona i nā pae mua, he mea nui loa ka nānā mau ʻana i nā maʻi, ʻoiai inā he mau mea pilikia kou e like me ka momona, ka maʻi diabetes, a me ke cholesterol kiʻekiʻe. A laila wale nō hiki iā ʻoe ke ʻike mua i kēia maʻi.

He aha nā pilikia ʻē aʻe e hiki ke hana ma muli o MASH?

Inā ʻaʻole mālama pono ʻia ʻo MASH, hiki iā ia ke alakaʻi i nā pilikia koʻikoʻi, i kekahi manawa e hoʻoweliweli ana i ke ola. Eia lākou:

• ʻO ka fibrosis akepaʻa: He ʻōpala kēia o ke akepaʻa. I ka hala ʻana o ka manawa, hōʻiliʻili kēia ʻōpala, e alakaʻi ana i ka cirrhosis.
• Cirrhosis: He kūlana kēia kahi e lilo ai ke akepaʻa i ʻeha nui a ua hoʻopilikia ʻia kāna hana. He kūlana mau loa kēia, ʻo ia hoʻi he paʻakikī ke hoʻohuli.
• Ka hāʻule ʻana o ke akepaʻa: Ua pau ka hana pono ʻana o ke akepaʻa. Hiki ke hana koke ʻia kēia. Inā hana ʻia kēia, pono paha ʻoe i ke kōkua lapaʻau koke a i ʻole kahi hoʻoili akepaʻa.
• ʻO ka maʻi kanesa Hepatocellular: Hoʻonui ka MASH i ka pilikia o ka hoʻomohala ʻana i kēia ʻano maʻi kanesa ate maʻamau.
• Maʻi puʻuwai: ʻO ka poʻe me MASH e ʻoi aku ka nui o ka pilikia o ka loaʻa ʻana o nā maʻi e pili ana i ka puʻuwai e like me ka hōʻeha puʻuwai a me ka hahau.

E noʻonoʻo wale, hoʻomaka nā mea a pau me kahi momona liʻiliʻi i loko o ke ake. ʻO ia ke kumu a mākou e ʻōlelo nei, mai hoʻowahāwahā i ka mea liʻiliʻi loa.

Pehea e ʻike ai nā kauka i ka maʻi MASH?

No ka mea, ʻaʻole i hoʻomaka mua ka MASH i nā hōʻailona, ​​aia kekahi mau hana e pono ai ʻoe e hana e ʻike ai. E hana mua ke kauka i kahi hoʻokolokolo kino. A laila e nīnau lākou iā ʻoe e pili ana i nā kūlana olakino ʻē aʻe e hoʻonui ai i kou pilikia o ka loaʻa ʻana o ka MASH (e.g., diabetes, cholesterol). Eia kekahi, hiki iā lākou ke hana i kēia mau hoʻokolohua:

Nā hoʻāʻo koko

E kauoha aku kāu kauka i nā hoʻāʻo koko e nānā i ka hōʻino ʻia o ke akepaʻa a i ʻole ka mumū. Hiki i kēia mau mea ke komo pū me:

• CBC (Helu Koko Piha): Helu piha o nā ʻāpana koko.
• BMP (Basic Metabolic Panel): Hoʻāʻo kaʻina hana metabolic kumu.
• Panel lipid: E nānā i nā pae momona e like me ka cholesterol a me nā triglycerides.
• Hemoglobin A1C: He hoʻāʻo e loiloi i ka kaohi ʻana o ka maʻi diabetes.

Nā hoʻokolohua kiʻi

Hiki i kēia mau hoʻokolohua ke kiʻi i nā kiʻi (nā kiʻi) o loko o kou ake. E nānā kāu kauka i kēia mau kiʻi e nānā i nā loli i loko o kou ake e pili ana i ke kūlana MASH. Hiki ke hana ʻia nā hoʻokolohua e like me kēia:

• ʻIke CT (ʻIke CT - ʻIke Tomography i hoʻopili ʻia)
• ʻO ke kiʻi ʻana o ka ultrasound
• FibroScan®: He ʻano ultrasound kūikawā kēia e ana i ka paʻakikī o ke akepaʻa. Hiki i kēia ke hāʻawi i kahi manaʻo o ka fibrosis akepaʻa.
• ʻO ka magnetic resonance elastography a me ka proton density fat fraction (MRE-PDFF): Hiki i kēia ke ana pololei i ka nui o ka momona i loko o ke akepaʻa.

Biopsy akepaʻa

I kekahi manawa, pono paha kāu kauka e lawe i kahi laʻana liʻiliʻi o nā ʻiʻo mai kou akepaʻa i kapa ʻia he biopsy akepaʻa. E nānā kekahi kauka lapaʻau i ka laʻana ma lalo o kahi microscope e nānā i ka momona, ka mumū, a me ka ʻeha ma ke akepaʻa. ʻO ka biopsy akepaʻa ke ala maikaʻi loa e ʻike pololei ai i ka MASH.

Eia kekahi, hiki i kāu kauka ke hana i nā hoʻokolohua ʻē aʻe e hoʻoholo ai inā ma muli o kekahi maʻi akepaʻa kāu mau hōʻailona.

He aha nā lāʻau lapaʻau no MASH?

ʻO ke kumu nui o ka mālama ʻana no MASH, ʻo ia ka hoʻomaikaʻi ʻana i ke olakino metabolic o kou kino a pale i ka hōʻino hou ʻana i kou akepaʻa. Hiki i kāu hoʻolālā mālama ke komo pū me:

Nā loli o ke ʻano o ka nohona

No ke kāohi ʻana i ka MASH, he mea nui e lawe i kahi meaʻai olakino, e hana ikaika, a e hōʻemi i ke kaumaha. Hiki i kāu kauka ke paipai i nā hoʻololi nohona e like me:

• ʻAi i ka ʻai olakino: ʻO kahi hoʻolālā ʻai maikaʻi e kōkua ai i ka kaohi ʻana i ka MASH ʻo ia ka ʻai Mediterranean a i ʻole ka ʻai haʻahaʻa-carb . I ka pōkole, e ʻai i nā mea kanu hou aʻe, nā huaʻai, nā legumes, nā palaoa fibrous, nā protein maikaʻi (iʻa, moa), a me nā momona olakino (avocado, ʻaila ʻoliva, nati). Pono ʻoe e hōʻemi i nā mea ʻono, nā mea momona, a me nā meaʻai wikiwiki e like me ka hiki.
• Ke hana nei: ma ka liʻiliʻi hoʻokahi manawa i ka puleE ho'āʻo e hana i 150 a 300 mau minuke o ka hoʻoikaika kino aerobic ikaika waena. ʻO nā laʻana e like me ka hele wāwae wikiwiki, ka holo ʻana, ke kaʻa paikikala, a me ka ʻauʻau ʻana.
• E hōʻalo loa i ka waiʻona: ʻOiai kahi liʻiliʻi o ka waiʻona hiki ke hoʻokaumaha i kou akepaʻa, no laila he mea nui e haʻalele loa i ka waiʻona.

Lāʻau lapaʻau

Hiki i kāu kauka ke kuhikuhi i kekahi mau lāʻau lapaʻau e kōkua i ka hōʻemi ʻana i nā hōʻailona, ​​​​e like me ka ʻeha, i hoʻokumu ʻia e MASH. Eia kekahi laʻana:

• ʻO Resmetiron (Rezdiffra®): Hiki i kēia lāʻau lapaʻau ke kōkua i ka hōʻemi a hoʻohuli paha i ka ʻeha o ke akepaʻa i hoʻokumu ʻia e MASH. ʻO ia wale nō ka lāʻau i ʻāpono ʻia e ka U.S. Food and Drug Administration (FDA) e mālama i ka MASH i nā pae 2 a me 3 o ka fibrosis.
• Nā agonists GLP-1: Kōkua kēia mau lāʻau i ka hōʻemi ʻana i ka mumū a me ka momona i loko o ke ake. ʻO nā laʻana e komo pū me ka liraglutide (Victoza®, Saxenda®), semaglutide (Ozempic®, Wegovy®), a me ka tirzepatide (Mounjaro®, Zepbound®). Hoʻohana pinepine ʻia kēia mau mea e mālama i ka maʻi diabetes.

Eia kekahi, hiki i kāu kauka ke kuhikuhi i nā lāʻau lapaʻau a i ʻole nā ​​​​mea hoʻohui ʻē aʻe. No ka laʻana, hiki ke ʻōlelo ʻia kahi lāʻau lapaʻau maʻi diabetes i kapa ʻia ʻo pioglitazone (Actoplus Met XR®) a i ʻole kahi mea hoʻohui e like me ka huaora E.

Ke hana nei nā kānaka noiʻi i nā hoʻokolohua lapaʻau e ʻimi i nā lāʻau lapaʻau hou no MASH. Hiki iā ʻoe ke kamaʻilio me kāu kauka e pili ana inā kūpono ʻoe e komo i ia ʻano hoʻokolohua.

ʻO ke ʻoki kino no ka pohō kaumaha (ʻoki kino Bariatric)

Inā momona loa ʻoe a loaʻa iā ʻoe ka maʻi akepaʻa koʻikoʻi, ʻo ke ʻoki pohō kaumaha (ʻoki bariatric) kekahi koho lapaʻau ʻē aʻe. Hiki i ke ʻoki lima gastric (wehe ʻana i kahi ʻāpana o ka ʻōpū) a i ʻole ke ʻoki bypass gastric (hoʻemi ʻana i ka ʻōpū) ke hāʻawi i nā pono aʻe:

• Kōkua i ka hoʻemi ʻana i ke kaumaha o ke kino.
• Hiki ke hoʻemi ʻia ka pōʻino o ke akepaʻa i hana ʻia e MASH i kekahi ʻano, a malia paha e hoʻohuli ʻia.
• Hoʻemi nui i ka pilikia o ka hoʻomohala ʻana i ka cirrhosis, ka maʻi ʻaʻai ate, a me ka pono o ka hoʻoili ʻana i ke ake.

Hiki ke ho'ōla loa ʻia ʻo MASH?

ʻAʻole hiki ke ho'ōla mau ʻia ka MASH. Eia nō naʻe, inā ʻike mua ʻia ka maʻi a hoʻomaka koke ʻia ka mālama ʻana, hiki ke hoʻohuli ʻia a pale ʻia paha mai ka lilo ʻana i mea ʻino. ʻO ke ʻano kēia, aia kahi manawa kūpono e hiki ke pale ʻia ka hōʻino hou ʻana i ke akepaʻa.

ʻEhia ka lōʻihi e hiki ai i kahi kanaka me MASH ke ola mau?

Aia kou manaʻolana ola ma ka nui o ka pōʻino i hana ʻia i kou akepaʻa e MASH. Inā ʻike ʻia ka maʻi a mālama ʻia i ka wā mua, hiki i ka hapa nui o ka poʻe ke ola i kahi ola maʻamau.Eia nō naʻe, i ka holomua ʻana o ka maʻi i nā pae holomua, piʻi ka pilikia o ka make mua ʻana mai nā pilikia e like me ka hāʻule ʻana o ke akepaʻa a me ke kanesa akepaʻa. Eia nō naʻe, hiki i ka lāʻau lapaʻau ke hoʻolohi i ka holomua o ka maʻi a hoʻomaikaʻi i ke ʻano o ke ola. ʻO ka hoʻomaka ʻana i ka lāʻau lapaʻau i ka wā hikiwawe loa ke ala maikaʻi loa e hoʻokō ai i nā hopena maikaʻi loa.

Āhea wau e ʻike ai i ke kauka?

Inā luhi mau ʻoe, ʻeha a ʻoluʻolu ʻole paha ma ka ʻaoʻao ʻākau o luna o kou ʻōpū, a i ʻole he mau hōʻailona e like me ka pohō kaumaha i wehewehe ʻole ʻia, he mea nui e ʻike i ke kauka. He mau hōʻailona paha kēia e hewa ana kekahi mea me kou akepaʻa. E hana kāu kauka i nā hoʻokolohua e ʻike ai inā he MASH a i ʻole kekahi maʻi akepaʻa ʻē aʻe.

E hoʻomanaʻo, ʻo kekahi mau kūlana olakino, e like me ka momona a me ka maʻi diabetes type 2, e hoʻonui i kou pilikia o ka loaʻa ʻana o ka MASH. Inā loaʻa iā ʻoe kekahi o kēia mau kūlana, e nānā mau kāu kauka i ka hana o kou ake.

ʻO ka mea hope loa, nā mea nui e pono ai ʻoe e hoʻomanaʻo

Ke loaʻa iā ʻoe kahi hōʻailona o MASH (metabolic dysfunction-associated steatohepatitis), hiki iā ʻoe ke manaʻo i ka nui o ka haʻalulu a me ka makaʻu. Inā loaʻa iā ʻoe nā maʻi e like me ka momona, ke koko kiʻekiʻe, a i ʻole ke kolamu kiʻekiʻe, e noʻonoʻo paha ʻoe, "ʻO wau anei ke kuleana no kēia?"

Akā, e hoʻomanaʻo i hoʻokahi mea. ʻAʻole hewa kekahi o kēia mau kūlana, me MASH. Ke nānā nei kāu hui lapaʻau i kēia manawa, ʻaʻole i ka wā i hala. E wehewehe lākou iā ʻoe i nā ʻanuʻu hiki iā ʻoe ke hana e mālama ai iā MASH. A e noho pū lākou me ʻoe i kēlā me kēia ʻanuʻu o ke ala. No laila, mai makaʻu.

ʻO ka mea nui loa, ʻo ia ka makaʻala i nā hōʻailona, ​​e kiʻi i nā hoʻokolohua lapaʻau kūpono inā he mau mea pilikia, a e hahai i nā ʻōlelo aʻoaʻo lapaʻau. A laila hiki iā kākou ke hoʻopakele i ko kākou akepaʻa mai kēia ʻenemi leo ʻole.

ʻO MASH, akepaʻa momona, cirrhosis, maʻi ʻaʻai akepaʻa, maʻi kō, momona nui, cholesterol