Ngā tohu o te ate mōmona (fatty liver): te tikanga o te kōeke 1, 2 me te 3, te ingoa hou MASLD, me ngā mea e āwhina ana

Ko te ate mōmona (fatty liver), ko te tikanga kua kohi te ngako i roto i te ate. Koia te mate ate roa e tino kitea ana puta noa i te ao, e pā ana ki neke atu i te 30% o te tangata o te ao, ā, ki te 24% pea o ngā pakeke i Amerika.

E rua ngā momo matua:

• Te ate mōmona e hono ana ki te taumaha, te huka toto me ngā ngako toto (metabolic). Koia te momo e tino kitea ana.
• Te ate mōmona nā te waipiro, nā te inu nui rawa i te waipiro te nuinga.

Ngā ingoa hou. I Hune 2023 i hurihia ngā ingoa e ngā rōpū ate o te ao:

• ko te mate ate mōmona kore-waipiro (NAFLD) kua huri hei mate ate ngako e hono ana ki te hapa pūngao (MASLD)
• ko te ate mōmona kore-waipiro me te kakā (NASH), te momo kakā, kua huri hei te kakā ate ngako e hono ana ki te hapa pūngao (MASH)
• ko MetALD mō te hunga he momo metabolic tō rātou, ā, he nui ake anō tā rātou inu waipiro

Ka whakaahua ngā ingoa hou i te take, kaua i ngā mea kāore te tangata e mahi, ā, kua whakarērea ngā kupu i whakaarohia e ētahi he whakaiti. Ka whakamahia pea e tō pūrongo tētahi o ngā ingoa e rua: he ōrite te mate o NAFLD me MASLD.

I tētahi pūrongo matawai oro (ultrasound), ko te kōeke (grade) e whakaahua ana i te nui o te ngako e kitea ana i te ate. Mā te ngako ka mārama ake te ate i te matawai.

Kōeke matawai oro	Te tikanga i te nuinga o te wā
Kōeke 1 (māmā)	He iti te ngako. He tino noa, ā, koia te māmā rawa ki te huri whakamuri
Kōeke 2 (waenga)	He nui ake te ngako; he mārama kitea te kanapa ake o te ate
Kōeke 3 (taumaha)	He nui te ngako; he uaua te kite i ngā wāhanga hōhonu o te ate i te matawai

Ehara te kōeke i te ōrite ki te tūkino. Ka whakaatu te matawai oro i te ngako, kaua i te kakā, i te nawe rānei. Ka taea he nawe tō tētahi he kōeke 1 tōna, ā, kāore pea he nawe o tētahi he kōeke 3. Nō reira ahakoa te kōeke, he ōrite te mahi e whai ake nei: he tatau whakamātautau toto (FIB-4), ā, i ētahi wā he matawai motuhake hei tirotiro i te nawe, me ngā tirotiro mō te mate huka, te cholesterol me te pēhanga toto.

He mōrearea rānei te ate mōmona kōeke 1? Ko ia anake, kāore i te nuinga o te wā, ā, ka ngaro pea. Engari he tohu whakatūpato: ko ngā mea e kohi ai te ngako ki te ate, ka piki anō te tūponotanga o te mate huka momo 2 me te mate manawa.

I te nuinga kāore he tohu. He maha ngā wā ka kīia te ate mōmona he mate wahangū. Ko te nuinga o te tangata ka mōhio mā te tūpono, i tētahi matawai, whakamātautau toto rānei i mahia mō tētahi take kē.

Ina puta ngā tohu, he rangirua:

• te tino ngenge, te māuiui whānui rānei
• he ānini mamae, he kino rānei te rongo i te taha matau o runga o te puku, i raro i ngā rara

Ngā wāhanga e whā (ko te tuatahi anake ka pā ki te nuinga):

1. Ate mōmona (steatosis): he ngako i te ate, kāore he tūkino
2. MASH (ko NASH i mua): kua kakā te ate
3. Fibrosis: he nawe, engari i te nuinga e pai tonu ana te mahi a te ate
4. Cirrhosis: he nawe taumaha, mau tonu

Ngā tohu o te cirrhosis, te wāhanga mutunga:

• kōwhai te kiri, kōwhai rānei te mā o ngā karu (mate kōwhai, jaundice)
• he puku pupuhi, he waewae, he rekereke, he raparapa pupuhi rānei
• he kiri mangeo, māmā te maru, te rere toto rānei
• kore hiakai, heke te taumaha, hiahia ruaki
• ngā ia toto whero iti rite ki te pūngāwerewere i te kiri, ngā kapu ringa whero kōpurepure
• te rangirua, te uaua o te arotahi, te kōrero mangungu rānei
• te ruaki toto, te tūtae tino pōuri, pango rānei, he ohotata tēnei

He tata te hono o te ate mōmona ki te āhua o te whakahaere a te tinana i te huka me te ngako. He nui ake te tūponotanga mēnā kei a koe:

• he taumaha tōpana, inarā he nui te ngako i te hope me te puku
• te mate huka momo 2, te mate huka tōmua, te ātete inihurini (insulin resistance) rānei
• he pēhanga toto teitei, he cholesterol, triglycerides teitei rānei
• te metabolic syndrome (he maha o ēnei i te wā kotahi)
• te PCOS
• he kai kino ki te hauora, he iti rānei te korikori tinana
• he pakeke neke atu i te 50

I Amerika, ko te hunga Hispanic e tino pāngia ana. Ka pāngia anō ngā tamariki: tata ki te 10% o ngā tamariki o Amerika e 2 ki te 19 tau te pakeke he ate mōmona tō rātou.

Kāore e tika kia taumaha tōpana koe. Ka taea he ate mōmona tō te hunga he taumaha hauora tō rātou, inarā mēnā he mate huka, he ngako tāpiri rānei i te hope.

Ka puta i te waipiro tōna ake momo ate mōmona, ā, ka kino ake te momo metabolic i a ia. Ka whakamārama tā mātou aratohu PCOS i tētahi o ngā mate taiaki e hono ana ki a ia.

I te nuinga ka kitea te ate mōmona mā te tūpono. Kātahi ka tirotiro ngā rata i te nui o tōna take:

• Ngā whakamātautau toto ate (ALT me AST). He teitei ēnei i te nuinga o te wā, engari ka taea he noa ahakoa he ate mōmona, he nawe rānei, nō reira kāore te hua noa e whakakore i te mate.
• Ka whakaatu te matawai oro (ultrasound) i te ngako i te ate, ā, ka hoatu i te kōeke. Ka taea anō e ngā matawai CT me te MRI te whakaatu.
• He tatau nawe (FIB-4), ka tātaihia mai i tō pakeke, te ALT, te AST me te tatau pereti toto (platelets). Ko te tatau i raro iho i te 1.3, ko te tikanga kāore pea he nawe kua kaha; i te nuinga ka tirotirohia anōtia ia 1 ki te 2 tau. Ki te teitei ake te tatau, ka haere ki te whakamātautau e whai ake nei.
• He matawai motuhake (elastography), pērā i te FibroScan, e ine ana i te mārō o te ate, he whakamātautau toto ELF rānei e rapu ana i te nawe.
• He biopsy ate, he tauira iti rawa ka tangohia ki te ngira, koia anake te whakamātautau e whakaū ana i te MASH. I ētahi wā anake ka hiahiatia.

Ka tirotiro anō ngā rata i ngā mate e haere tahi ana me te ate mōmona: te huka toto (HbA1c), te cholesterol me ngā triglycerides, te pēhanga toto me te taumaha, ā, ka pātai mō te waipiro.

Mō te nuinga, kāore: he ngako anake i te ate i ngā wā katoa, kāore he kakā, he nawe rānei. Engari i ētahi ka āta kino haere:

• ka pā te MASH (kakā) ki tētahi wāhanga iti o te hunga he ate mōmona tō rātou, ki te 1.5 ki te 6.5% pea o ngā pakeke o Amerika
• ka whai mai pea te fibrosis, kātahi ko te cirrhosis i roto i ngā tau
• ka arahina pea e te cirrhosis ki te rahunga ate (liver failure), te rere toto o roto me te mate pukupuku ate

Ko te teitei ake o tō tatau nawe, ko te tata ake o te aroturuki.

Mō te nuinga, ko te manawa te mōrearea nui ake. Ko ngā take e kohi ai te ngako ki te ate, ka piki anō te tūponotanga o te mate huka momo 2, te manawa-hē (heart attack) me te ikura roro (stroke). Mā te maimoa i te taumaha, te huka toto, te pēhanga toto me te cholesterol e tiakina ai ngā mea e rua.

Āe, inarā i ngā wāhanga tōmua. Ko te maimoatanga matua ko te āhua o te noho, ā, e whai hua ana:

• Whakahekea āta haere te taumaha mēnā he taumaha tōpana tōu. Mā te heke o te 3 ki te 5% o te taumaha o tō tinana e iti iho ai pea te ngako i te ate; mā te 7 ki te 10% e iti iho ai pea te kakā me te nawe. Kaua e whai i ngā kai whakaheke taumaha tere rawa (crash diets): mā te tino tere o te heke o te taumaha e kino ake ai pea te mate ate.
• Kia nui ake te korikori: kia 150 meneti i te iti rawa o te korikori i te wiki, pērā i te hīkoi tere. Ka āwhina te korikori tinana ahakoa kāore e tino rerekē tō taumaha.
• Kainga he kai hauora, taurite hoki: kia nui ake ngā huawhenua, ngā huarākau, ngā pata kākano katoa, ngā pī me te ika, kia iti iho ngā inu huka, ngā kai reka me ngā kai tukatuka.
• Waipiro: kaua e neke atu i te 14 waeine i te wiki, kia horahia ki ētahi rā. Mēnā he nawe tōu, he mate ate nā te waipiro rānei, tērā pea ka tohutohu tō rata kia whakamutua katoatia.
• Whakamutua te kai paipa, ā, kia maimoatia te mate huka, te pēhanga toto me te cholesterol.

Ngā rongoā: kāore he rongoā mō te ate mōmona māmā. Mō te MASH, ka whakamahia pea e tētahi mātanga te pioglitazone, te vitamin E rānei mō ētahi tāngata. I Amerika, ka taea te tuku i te resmetirom (i whakaaetia i te 2024) me te semaglutide (i whakaaetia i te 2025) mō te MASH me te nawe waenga ki te nawe kua kaha, kāore he cirrhosis, i te taha o te kai me te korikori tinana.

Ko tēhea rongoā, ā, e hia te nui, mā tō rata tērā e whakatau. Kaua e kai i te vitamin E horopeta nui, i ngā rongoā otaota, i ngā hua “liver detox” rānei i a koe anō: ka taea e ētahi pire āpiti te tūkino i te ate. Pātai ki tētahi rata, kaiwhakarite rongoā (pharmacist) rānei i te tuatahi.