Department of Medicine, Division of Gastroenterology and Hepatology, Federal University of São Paulo, São Paulo, Brazil.
Nutrition. 2010 Nov-Dec;26(11-12):1094-9. doi: 10.1016/j.nut.2009.09.001. Epub 2009 Dec 22.
We evaluated the effect of diet therapy as exclusive treatment on insulin resistance, biochemical parameters of metabolic syndrome, and degree of hepatic steatosis in patients with non-alcoholic fatty liver disease.
Thirty-one patients with non-alcoholic fatty liver disease received a diet with a reduction of 500 to 1000 cal/d, containing 15% protein, 55% carbohydrates, and 30% fat, for 6 mo. At entry and 6 mo after dietary instructions, degrees of hepatic steatosis and visceral obesity were assessed by computed tomography; serum aspartate aminotransferase, alanine aminotransferase, γ-glutamyl transferase, glucose, triacylglycerols, and high-density lipoprotein cholesterol were measured by automated methods. Body mass index, waist circumference, waist-to-hip ratio, and food intake (7-d diary) were also evaluated. At the end of follow-up, the patients were classified as adherent or non-adherent to treatment according to a weight loss of more or less than 5% of initial body weight, respectively.
Seventeen patients were classified as adherent (group 1) and 14 as non-adherent (group 2). Group 2 only presented a significant reduction in body mass index and waist circumference. In contrast, in group 1, in addition to significant improvement of all anthropometric parameters, a significant reduction was observed in alanine aminotransferase and γ-glutamyl transferase levels, homeostasis model assessment for insulin resistance, visceral fat and tomographic liver density, together with an increase in serum high-density lipoprotein cholesterol levels. These patients presented a significant decrease in total energy intake and in total and saturated fats.
Nutritional intervention as exclusive treatment, with a loss of at least 5% of initial weight, is effective in the treatment of non-alcoholic fatty liver disease.
我们评估了饮食疗法作为唯一治疗方法对胰岛素抵抗、代谢综合征生化参数和非酒精性脂肪肝患者肝脂肪变性程度的影响。
31 例非酒精性脂肪肝患者接受了为期 6 个月的饮食治疗，每天减少 500-1000 卡路里，其中蛋白质占 15%，碳水化合物占 55%，脂肪占 30%。在开始饮食指导和 6 个月后，通过计算机断层扫描评估肝脂肪变性和内脏肥胖的程度；通过自动方法测量血清天门冬氨酸转氨酶、丙氨酸转氨酶、γ-谷氨酰转移酶、血糖、三酰甘油和高密度脂蛋白胆固醇。还评估了体重指数、腰围、腰臀比和食物摄入量（7 天日记）。随访结束时，根据体重减轻是否超过初始体重的 5%，将患者分为治疗依从组和非依从组。
17 例患者被分为依从组（组 1），14 例患者被分为非依从组（组 2）。组 2 仅在体重指数和腰围方面有显著降低。相比之下，在组 1 中，除了所有人体测量参数显著改善外，还观察到丙氨酸转氨酶和γ-谷氨酰转移酶水平、胰岛素抵抗的稳态模型评估、内脏脂肪和肝脏 CT 密度降低，同时血清高密度脂蛋白胆固醇水平升高。这些患者的总能量摄入以及总脂肪和饱和脂肪摄入显著减少。
作为唯一治疗方法的营养干预，体重减轻至少 5%，对非酒精性脂肪肝的治疗有效。
