Non-Alkolik Yağlı Karaciğer Hastalığında Güncel Hemşirelik Yaklaşımları

Abstract

Non-alkolik yağlı karaciğer hastalığı (NAFLD), sedanter yaşam tarzı, sağlıksız beslenme alışkanlıkları, obezite ve metabolik risk faktörlerindeki artış nedeniyle dünya genelinde giderek yaygınlaşan önemli bir halk sağlığı sorunudur. NAFLD yalnızca karaciğere özgü bir hastalık olmayıp aynı zamanda sistemik metabolik disfonksiyonun bir göstergesi olarak değerlendirilmektedir. Hastalık, basit steatozdan non-alkolik steatohepatit, fibrozis, siroz ve hepatoselüler karsinoma kadar ilerleyebilen geniş bir klinik spektruma sahiptir. Günümüzde spesifik farmakolojik tedavi seçeneklerinin sınırlı olması nedeniyle yaşam tarzı değişiklikleri hastalık yönetiminin temelini oluşturmaktadır. Kilo kontrolü, sağlıklı beslenme, düzenli fiziksel aktivite ve metabolik risk faktörlerinin yönetimi NAFLD’nin kontrolünde kritik öneme sahiptir. Ancak bu değişikliklerin sürdürülebilirliği, bireyin davranış değişikliği sürecine aktif katılımını gerektirmektedir. Hemşireler; hasta eğitimi, danışmanlık, motivasyonel görüşme, öz-yönetim desteği ve düzenli izlem yoluyla hastaların sağlıklı yaşam davranışları geliştirmesinde önemli rol üstlenmektedir. Ayrıca hemşireler, bireylerin tedaviye uyumunu artırmakta, yaşam kalitesini desteklemekte, komplikasyonların önlenmesine katkı sağlamakta ve uzun dönem hastalık yönetiminde aktif görev almaktadır. Multidisipliner bakım koordinasyonuna katkı sağlayarak hastaların fiziksel, psikolojik ve sosyal gereksinimlerinin bütüncül biçimde değerlendirilmesini desteklemektedir. Bunun yanında erken tanılama, risk değerlendirmesi ve bireye özgü bakım planlarının oluşturulması süreçlerinde de önemli sorumluluklar üstlenmektedirler. Bu derlemede, NAFLD’nin klinik özellikleri, risk faktörleri, korunma stratejileri ve yaşam tarzı temelli yönetim yaklaşımları ele alınmış; hemşirelik bakımının hasta eğitimi ve sürdürülebilir sağlık davranışlarının geliştirilmesindeki rolü güncel literatür doğrultusunda değerlendirilmiştir.

Keywords

• hemşirelik bakımı
• non-alkolik yağlı karaciğer hastalığı
• sağlık davranışı

Supporting Institution

Yoktur.

Ethical Statement

Bu çalışma derleme türünde hazırlanmış olup insan veya hayvan katılımcılar üzerinde herhangi bir veri toplama işlemi gerçekleştirilmediğinden etik kurul onayı gerekmemektedir. Çalışma Helsinki Bildirgesi ilkelerine uygun olarak hazırlanmıştır.

Thanks

Yoktur.

Current Nursing Approaches to Non-Alcoholic Fatty Liver Disease

Abstract

Non-alcoholic fatty liver disease (NAFLD) is an increasingly prevalent global public health problem associated with sedentary lifestyle, unhealthy dietary habits, obesity, and the rising prevalence of metabolic risk factors. NAFLD is considered not only a liver-specific disease but also an indicator of systemic metabolic dysfunction. The disease encompasses a broad clinical spectrum ranging from simple steatosis to non-alcoholic steatohepatitis, fibrosis, cirrhosis, and hepatocellular carcinoma. Due to the limited availability of specific pharmacological treatment options, lifestyle modifications constitute the cornerstone of NAFLD management. Weight control, healthy nutrition, regular physical activity, and management of metabolic risk factors play a critical role in disease control. However, the sustainability of these changes requires the individual’s active participation in the behavior change process. Nurses play an important role in promoting healthy lifestyle behaviors through patient education, counseling, motivational interviewing, self-management support, and regular follow-up. In addition, nurses contribute to improving treatment adherence, supporting quality of life, preventing complications, and actively participating in long-term disease management. By contributing to multidisciplinary care coordination, nurses also support the holistic evaluation of patients’ physical, psychological, and social needs. Furthermore, they undertake important responsibilities in early diagnosis, risk assessment, and the development of individualized care plans. This review discusses the clinical characteristics, risk factors, prevention strategies, and lifestyle-based management approaches of NAFLD and evaluates the role of nursing care in patient education and the promotion of sustainable health behaviors in light of the current literature.

Keywords

• nursing care
• non-alcoholic fatty liver disease
• health behavior

Supporting Institution

None.

Ethical Statement

This study was prepared as a review article, and since no data were collected from human or animal participants, ethical approval was not required. The study was conducted in accordance with the principles of the Declaration of Helsinki.

Thanks

None.

References

1. Abenavoli, L., Di Renzo, L., Boccuto, L., Alwardat, N., Gratteri, S., & De Lorenzo, A. (2018). Health benefits of Mediterranean diet in nonalcoholic fatty liver disease. Expert Review of Gastroenterology & Hepatology, 12(9), 873–881. https://doi.org/10.1080/17474124.2018.1503947
2. Al-Dayyat, H. M., Rayyan, Y. M., & Tayyem, R. F. (2018). Non-alcoholic fatty liver disease and associated dietary and lifestyle risk factors. Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 12(4), 569– 575. https://doi.org/10.1016/j.dsx.2018.03.016
3. Amiri, S., Mahmood, N., Junaidi, S., & Khan, M. A. (2024). Lifestyle interventions improving health-related quality of life: A systematic review and meta-analysis of randomized control trials. Journal of Education and Health Promotion, 13, 193. https://doi.org/10.4103/jehp.jehp_1156_23
4. Ando, Y., & Jou, J. H. (2021). Nonalcoholic fatty liver disease and recent guideline updates. Clinical Liver Disease, 17(1), 23–28. https://doi.org/10.1002/cld.1045
5. Arshad, T., Paik, J. M., Biswas, R., Alqahtani, S. A., Henry, L., & Younossi, Z. M. (2021). Nonalcoholic fatty liver disease prevalence trends among adolescents and young adults in the United States, 2007–2016. Hepatology Communications, 5(10), 1676–1688. https://doi.org/10.1002/hep4.1760
6. Correia, J. C., Waqas, A., Assal, J. P., Davies, M. J., Somers, F., Golay, A., & Pataky, Z. (2023). Effectiveness of therapeutic patient education interventions for chronic diseases: A systematic review and meta-analyses of randomized controlled trials. Frontiers in Medicine, 9, Article 996528. https://doi.org/10.3389/fmed.2022.996528
7. Çelik, F., Yüksel, M., ve Bektaş, H. (2023). Sessiz epidemi: Metabolik disfonksiyon ilişkili karaciğer yağlanması hastalığının önlenmesine ve yönetilmesine yönelik güncel yaklaşımlar [Silent epidemic: Current approaches to the prevention and management of metabolic dysfunction-associated fatty liver disease]. Artuklu International Journal of Health Sciences, 3(3), 343–348. Encyclopaedia Britannica. (2025). Liver. In Encyclopaedia Britannica. https://www.britannica.com/science/liver
8. European Association for the Study of the Liver (EASL), European Association for the Study of Diabetes (EASD), & European Association for the Study of Obesity (EASO). (2024). EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). Journal of Hepatology, 81(3), 492–542. https://doi.org/10.1016/j.jhep.2024.04.031

9. Fitch, M. I., Nicoll, I., & Burlein-Hall, S. (2024). Screening for psychosocial distress: A brief review with implications for oncology nursing. Healthcare, 12(21), Article 2167. https://doi.org/10.3390/healthcare12212167 Geh, D., Manas, D. M., & Reeves, H. L. (2021). Hepatocellular carcinoma in non-alcoholic fatty liver disease: A review of an emerging challenge facing clinicians. Hepatobiliary Surgery and Nutrition, 10(1), 59–75. https://doi.org/10.21037/hbsn-20-454
10. Gerges, S. H., Wahdan, S. A., Elsherbiny, D. A., & ElDemerdash, E. (2021). Non-alcoholic fatty liver disease: An overview of risk factors, pathophysiological mechanisms, diagnostic procedures, and therapeutic interventions. Life Sciences, 271, Article 119220. https://doi.org/10.1016/j.lfs.2021.119220
11. Hallsworth, K., & Adams, L. A. (2019). Lifestyle modification in NAFLD/NASH: Facts and figures. JHEP Reports, 1(6), 468–479. https://doi.org/10.1016/j.jhepr.2019.10.008 Herdman, T. H., Kamitsuru, S., ve Lopes, C. T. (Ed.). (2025). NANDA International Inc. hemşirelik tanıları: Tanımlar ve sınıflandırma 2024–2026 (R. Acaroğlu ve H. Kaya, Çev. Ed.). Nobel Tıp Kitabevi.
12. Huang, Y., Zhang, M., Liu, Y., & Wang, J. (2024). The effect of self-management on patients with chronic disease: The mediating role of self-efficacy. Healthcare, 12(21), Article 2151. https://doi.org/10.3390/healthcare12212151
13. Huppert, S. S., & Schwartz, R. E. (2023). Multiple facets of cellular homeostasis and regeneration of the mammalian liver. Annual Review of Physiology, 85, 469–493. https://doi.org/10.1146/annurev-physiol032822-094134
14. Hydes, T. J., Ravi, S., Loomba, R., & Gray, M. E. (2020). Evidence-based clinical advice for nutrition and dietary weight loss strategies for the management of NAFLD and NASH. Clinical and Molecular Hepatology, 26(4), 383–400. https://doi.org/10.3350/cmh.2020.0067 Jarhahzadeh, M., Alavinejad, P., Farsi, F., Husain, D., & Rezazadeh, A. (2021). The effect of turmeric on lipid profile, malondialdehyde, liver echogenicity and enzymes among patients with nonalcoholic fatty liver disease: A randomized double blind clinical trial. Diabetology & Metabolic Syndrome, 13(1), Article 112. https://doi.org/10.1186/s13098-021-00731-7
15. Kalra, A., Yetiskul, E., Wehrle, C. J., & Tuma, F. (2023). Physiology, liver. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK535438/ Kosmalski, M., & Mokros, Ł. (2025). Non-alcoholic fatty liver disease in everyday clinical practice: From diagnosis to therapy. Life, 15(4), Article 363. https://doi.org/10.3390/life15040363 Lv, H., & Liu, Y. (2024). Management of non-alcoholic fatty liver disease: Lifestyle changes. World Journal of Gastroenterology, 30(22), 2829–2833. https://doi.org/10.3748/wjg.v30.i22.2829
16. Mitrovic, B., Milenkovic, V., Stefanovic, S., Mitrovic, M., Todorovic, S., & Soldatovic, I. (2022). Nonalcoholic fatty liver disease, metabolic syndrome, and type 2 diabetes mellitus: Where do we stand today? Archives of Medical Science, 19(4), 884–894. https://doi.org/10.5114/aoms/150639 Niederseer, D., Wernly, B., Aigner, E., Stickel, F., &
17. Datz, C. (2021). NAFLD and cardiovascular diseases: Epidemiological, mechanistic and therapeutic considerations. Journal of Clinical Medicine, 10(3), Article 467. https://doi.org/10.3390/jcm10030467 Niño de Guzmán Quispe, E., Martínez García, L., Orrego Villagrán, C., Heijmans, M., Sunol, R., FraileNavarro, D., Pérez-Bracchiglione, J., Ninov, L., SalasGama, K., Viteri García, A., & Alonso-Coello, P. (2021). The Perspectives of Patients with Chronic Diseases and Their Caregivers on Self-Management Interventions: A Scoping Review of Reviews. The patient, 14(6), 719–740. https://doi.org/10.1007/s40271-021-00514- 2Panahi, Y., Kianpour, P., Mohtashami, R., Atkin, S. L., Butler, A. E., Jafari, R., Khalili, R., & Sahebkar, A. (2018). Efficacy of artichoke leaf extract in nonalcoholic fatty liver disease: A pilot double-blind randomized controlled trial. Phytotherapy Research, 32(7), 1382–1387. https://doi.org/10.1002/ptr.6073
18. Pouwels, S., Sakran, N., Graham, Y., Leal, A., Pintar, T., Yang, W., Kassir, R., Singhal, R., Mahawar, K., & Ramnarain, D. (2022). Non-alcoholic fatty liver disease (NAFLD): A review of pathophysiology, clinical management and effects of weight loss. BMC Endocrine Disorders, 22(1), Article 63. https://doi.org/10.1186/s12902-022-00980-1
19. Ramachandran, P., Matchett, K. P., & Dobie, R. (2020). Single-cell technologies in hepatology: New insights into liver biology and disease pathogenesis. Nature Reviews Gastroenterology & Hepatology, 17(8), 457– 472. https://doi.org/10.1038/s41575-020-0304-x
20. Ross, M. H., ve Pawlina, W. (2013). Histoloji konu anlatımı ve atlas (Y. Yeni, Çev. Ed.). Palme Yayınevi. Salmanizadeh, F., Sabzevari, S., Shafieipour, S., Zahedi, M. J., & Sarafinejad, A. (2025). Challenges and needs in the management of non-alcoholic fatty liver disease from the perspective of gastroenterology and hepatology specialists: a qualitative study. BMC gastroenterology, 25(1), 396. https://doi.org/10.1186/s12876-025-03921-z
21. Shidfar, F. (2015). The effect of ginger (Zingiber officinale) on glycemic markers in patients with type 2 diabetes. Journal of Complementary and Integrative Medicine, 12(2), 165–170. https://doi.org/10.1515/jcim2014-0021
22. Soleimani, D., Paknahad, Z., & Rouhani, M. H. (2020). Therapeutic Effects of Garlic on Hepatic Steatosis in Nonalcoholic Fatty Liver Disease Patients: A Randomized Clinical Trial. Diabetes, metabolic syndrome and obesity : targets and therapy, 13, 2389– 2397. https://doi.org/10.2147/DMSO.S254555
23. Tapper, E. B., & Parikh, N. D. (2018). Mortality due to cirrhosis and liver cancer in the United States, 1999– 2016: Observational study. BMJ, 362, Article k2817. https://doi.org/10.1136/bmj.k2817
24. Toney-Butler, T. J., & Unison-Pace, W. J. (2023). Nursing admission assessment and examination. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK493211/ Trefts, E., Gannon, M., & Wasserman, D. H. (2017). The liver. Current biology : CB, 27(21), R1147–R1151. https://doi.org/10.1016/j.cub.2017.09.019
25. Van Name, M. A., Savoye, M., Chick, J. M., Galuppo, B. T., Feldstein, A. E., Pierpont, B., Johnson, C., Shabanova, V., Ekong, U., Valentino, P. L., Kim, G.,
26. Caprio, S., & Santoro, N. (2020). A low ω-6 to ω-3 PUFA ratio (n-6:n-3 PUFA) diet to treat fatty liver disease in obese youth. The Journal of Nutrition, 150(9), 2314–2321. https://doi.org/10.1093/jn/nxaa183 Wang, J. L., Jiang, S. W., Hu, A. R., Zhou, A. W., Hu, T., Li, H. S., Fan, Y., & Lin, K. (2024). Non-invasive diagnosis of non-alcoholic fatty liver disease: Current status and future perspective. Heliyon, 10(5), e27325. https://doi.org/10.1016/j.heliyon.2024.e27325 Yıldırım, J. G. (2026). Kronik hastalıkların özyönetiminde motivasyonel görüşme: Sistematik derleme ve meta-analiz [Motivational interviewing in selfmanagement of chronic diseases: A systematic review and meta-analysis]. Ordu Üniversitesi Hemşirelik Çalışmaları Dergisi, 9(2), 335–349. https://doi.org/10.38108/ouhcd.1505131
27. Younossi, Z. M., Corey, K. E., & Lim, J. K. (2021). AGA clinical practice update on lifestyle modification using diet and exercise to achieve weight loss in the management of nonalcoholic fatty liver disease: Expert review. Gastroenterology, 160(3), 912–918. https://doi.org/10.1053/j.gastro.2020.11.051
28. Zelber-Sagi, S., Salomone, F., & Mlynarsky, L. (2017). The Mediterranean dietary pattern as the diet of choice for non-alcoholic fatty liver disease: Evidence and plausible mechanisms. Liver international : official journal of the International Association for the Study of the Liver, 37(7), 936–949. https://doi.org/10.1111/liv.13435
29. Zhou, J., Yu, Y., Ding, L., Xu, P., & Wang, Y. (2021). Matcha green tea alleviates non-alcoholic fatty liver disease in high-fat diet-induced obese mice by regulating lipid metabolism and inflammatory responses. Nutrients, 13(6), Article 1950. https://doi.org/10.3390/nu13061950