From the Guidelines
The patient should prioritize reducing liver enzyme elevation by decreasing Tylenol use, alcohol consumption, and dietary fat intake, while also increasing protein consumption to improve low total protein and albumin levels, and schedule a follow-up appointment in two weeks to recheck liver enzymes. The provider's lab review shows no infection or anemia, with normal HgA1C, thyroid function, triglycerides, LDL cholesterol, and kidney function. However, there are three areas of concern that require attention. First, the patient's HDL (good cholesterol) is slightly low, so they should increase good saturated fats in their diet while decreasing trans fats, as recommended by the American Heart Association 1. Second, the elevated liver enzymes are particularly important to address as they may indicate liver stress or damage, which can be exacerbated by acetaminophen (Tylenol), alcohol, and high-fat diets, as noted in the American Gastroenterological Association medical position statement 1. Third, the low total protein and albumin levels indicate a need to increase protein consumption.
The patient's diet should be modified to reduce saturated fats, cholesterol, and trans-fatty acids, and to increase consumption of fruits, vegetables, grains, low-fat or nonfat dairy products, fish, legumes, poultry, and lean meats, as recommended by the American Heart Association 1. Additionally, the patient should limit salt intake to 6 g/d and limit alcohol intake, as excessive alcohol consumption can exacerbate liver enzyme elevation. The patient should also engage in at least 30 min of moderate-intensity physical activity on most days of the week, as recommended by the American Heart Association 1.
It is essential to address the elevated liver enzymes, as they may indicate underlying liver disease, and to monitor the patient's progress through regular follow-up appointments, as recommended by the American Gastroenterological Association 1. The patient should be educated on the importance of reducing liver enzyme elevation and the potential consequences of not addressing this issue, such as liver damage or disease. By prioritizing the reduction of liver enzyme elevation and increasing protein consumption, the patient can improve their overall health and reduce their risk of developing liver disease.
From the Research
Patient's Lab Results and Recommendations
- The patient's lab results show no sign of infection or anemia, with a normal HgA1C level 2.
- The patient's TSH and free T4 levels are within normal limits, indicating a healthy thyroid function.
- The patient's triglycerides and LDL (bad cholesterol) levels are within normal limits, which is a positive indicator of cardiovascular health 3.
- However, the patient's HDL (good cholesterol) level is slightly low, which may increase the risk of cardiovascular disease 4.
- The patient is advised to decrease their intake of bad trans fats and increase their intake of good saturated fats in their diet 5, 6.
- The patient's kidney function is normal, but their liver enzymes are elevated, which may be due to high Tylenol or alcohol intake, or a high-fat diet 3.
- The patient is recommended to reduce their Tylenol and alcohol intake, and decrease their fat intake to improve their liver function.
Dietary Recommendations
- The patient should ensure adequate protein intake to improve their total protein and albumin levels 2.
- Reducing saturated fat intake has been shown to reduce the risk of combined cardiovascular events by 21% 2.
- Replacing saturated fat with polyunsaturated fat or carbohydrate may be a useful strategy to reduce cardiovascular risk 2, 4.
- The patient should aim to limit their saturated fat intake to less than 10% of their total daily energy intake, and further reduce it to 5-6% if they have hypercholesterolemia 4.
- Increasing intake of fruits, vegetables, whole grains, low-fat dairy, and fish or other omega-3 fatty acids may help reduce cardiovascular risk 3.