体重减轻多少对非酒精性脂肪性肝病有效？
How Much Weight Loss is Effective on Nonalcoholic Fatty Liver Disease?
作者信息
Ghaemi Alireza, Taleban Fourugh Azam, Hekmatdoost Azita, Rafiei Alireza, Hosseini Vahid, Amiri Zohreh, Homayounfar Reza, Fakheri Hafez
机构信息
Department of Clinical Nutrition and Dietetics, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran.
Molecular and Cell Biology Center, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, IR Iran.
出版信息
Hepat Mon. 2013 Dec 7;13(12):e15227. doi: 10.5812/hepatmon.15227. eCollection 2013.
BACKGROUND
Nonalcoholic fatty liver disease (NAFLD) is the most common liver disease worldwide with no specific treatment. Weight loss is the most effective therapeutic strategy in its management; however, there is no consensus on its specifics. Thus, this study was conducted to evaluate the effects of weight loss on liver enzymes, markers of inflammation, oxidative stress and CK18-M30 (cytokeratin 18) as a biomarker of hepatocellular apoptosis.
OBJECTIVES
To study the effect of weight reduction diet as an exclusive treatment for NAFLD.
PATIENTS AND METHODS
Forty four patients with NAFLD received a diet including a 500 to 1000 kcal per day intake reduction as30% fat, 15% protein, and 55% carbohydrate for six months. Anthropometric parameters, alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma glutamyl transferase (GGT), lipid profile, malondialdehyde (MDA), TNF-α, IL-6, CK18-M30 were measured at baseline and at the end of the study. At the end of follow up, patients were classified as adherent or nonadherent to treatment according to a weight loss of ≥ 5%, or < 5% of initial body weight, respectively.
RESULTS
Twenty five patients were classified as adherent group and nineteen as nonadherent group (9.7% vs. 1.9% total body weight loss after 6 months, respectively). After 6 months, changes in adherent and nonadherent groups were as follows: reduction in body weight from 93.7 ± 15.8 kg to 84.2 ± 13.4 kg vs. 94 ± 16.6 kg to 92.2 ± 16.2 kg (P < 0.05), BMI from 32.7 ± 3.9 to 29.5 ± 3.2 vs.31.8 ± 5.4 to 31.1 ± 5.3 (P < 0.001), and waist circumference from 105.1 ± 12.6 cm to 97.4 ± 9.8 cm vs.106.8 ± 14.2 cm to 103.7 ± 14 cm (P < 0.001), respectively. Diastolic blood pressure was significantly decreased in adherent group (from 80.2 ± 5.1 mmHg to 76.9 ± 5 mmHg; P < 0.001). Also, total cholesterol, LDL, triglyceride, ALT, AST, GGT and CK18-M30 levels were significantly decreased in the adherent group compared to nonadherent group (P < 0.05).
CONCLUSIONS
This intervention offers a practical approach for treatment of patients with NAFLD with diet therapy.
背景
非酒精性脂肪性肝病（NAFLD）是全球最常见的肝脏疾病，尚无特效治疗方法。减肥是其治疗中最有效的策略；然而，在减肥的具体细节上尚未达成共识。因此，本研究旨在评估减肥对肝酶、炎症标志物、氧化应激以及作为肝细胞凋亡生物标志物的细胞角蛋白18-M30（CK18）的影响。
目的
研究减重饮食作为NAFLD唯一治疗方法的效果。
患者与方法
44例NAFLD患者接受一种饮食，即每天减少500至1000千卡的热量摄入，其中脂肪占30%，蛋白质占15%，碳水化合物占55%，持续6个月。在基线和研究结束时测量人体测量参数、丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）、γ-谷氨酰转移酶（GGT）、血脂、丙二醛（MDA）、肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）、CK18-M30。随访结束时，根据体重减轻是否≥初始体重的5%或<5%，将患者分别分类为治疗依从组或非依从组。
结果
25例患者被分类为依从组，19例为非依从组（6个月后总体体重减轻分别为9.7%和1.9%）。6个月后，依从组和非依从组的变化如下：体重从93.7±15.8千克降至84.2±13.4千克，而非依从组从94±16.6千克降至92.2±16.2千克（P<0.05）；体重指数（BMI）从32.7±3.9降至29.5±3.2，而非依从组从31.8±5.4降至31.1±5.3（P<0.001）；腰围从105.1±12.6厘米降至97.4±9.8厘米，而非依从组从106.8±14.2厘米降至103.7±14厘米（P<0.001）。依从组舒张压显著降低（从80.2±5.1毫米汞柱降至76.9±5毫米汞柱；P<0.001）。此外，与非依从组相比，依从组的总胆固醇、低密度脂蛋白、甘油三酯、ALT、AST、GGT和CK18-M30水平显著降低（P<0.05）。
结论
这种干预为采用饮食疗法治疗NAFLD患者提供了一种实用方法。
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