Selezneva K S, Isakov V A, Sentsova T B, Kirillova O O
Vopr Pitan. 2014;83(5):72-8.
Diet modification is widely used for the treatment of non.alcoholic steatohepatitis (NASH). Caloric restriction was shown to be effective in normalizing bldod lipid profile, increasing insulin sensitivity and subsequent normalization of aminotrasferases blood level. The aim of the study was to compare low-calorie diet (LCD) with isocaloric diet (ICD) in patients w,ith NASH. 174 NASH patients [86 females (39,43±1,53 years old) and 88 males (41,7±2,0), BMI 36,8±0,8 kg/m2] were randomly assigned (as 1:2) for LCD (1600-1700 kcal/day) or ICD (2500-2700 kcal/day) calculated according to patients'sex, age, resting energy expenditures and daily physical activity. Caloric restriction was achieved by decreasing consumption of carbohydrates and fat in LCD, whereas for ICD the caloric consumption was established according to the recommended daily values for proteins, fat and carbohydrates for ideal BMI for every patient. Blood chemistry and body composition were assessed at baseline and after 1 mo of prescribed diets. Compliance for the diet was also evaluated using previously validated questionnaire. After 1 mo of dietetic interventions total body mass and lean mass significantly decreased in both groups, but in LCD group it was significantly more prominent decrease in compare to ICD group (9,3±1,8 vs 6,2±1,7 kg and 6,6±0,4 vs 1,4±0,6 kg, p<0,05), whereas fat mass decreased better in ICD group (4,8±0,7 vs 2, 7±0,8kg, p<0,05). Mean ALT level was decreased in ICD group (77,5±41,7 vs 98,8±45,7, p<0,01), but not in LCD group (81,2±50,6 vs 77,2±31,8, p=NS) whereas blood cholesterol, triglycerides, high density lipoprotein woere significantly decreased in both groups. Moreover during the diet intervention in 72% of patients from LCD group ALT increased. Compliance index was much higher in ICD group, than in LCD group (85% vs 54%). Thus, one month of lCD leads to decrease in ALT activity in majority of NASH patients, higher loss of fat mass, lower loss of lean mass and associated with better compliance in compare to LCD.
饮食调整广泛用于非酒精性脂肪性肝炎（NASH）的治疗。热量限制已被证明可有效使血脂谱正常化，提高胰岛素敏感性并随后使转氨酶血液水平正常化。本研究的目的是比较NASH患者的低热量饮食（LCD）和等热量饮食（ICD）。174例NASH患者[86例女性（39.43±1.53岁）和88例男性（41.7±2.0岁），BMI 36.8±0.8kg/m²]被随机分配（比例为1:2）接受LCD（1600 - 1700千卡/天）或ICD（2500 - 2700千卡/天），根据患者的性别、年龄、静息能量消耗和日常身体活动进行计算。LCD通过减少碳水化合物和脂肪的摄入量来实现热量限制，而ICD则根据每个患者理想BMI的蛋白质、脂肪和碳水化合物的每日推荐值来确定热量消耗。在规定饮食的基线和1个月后评估血液化学和身体成分。还使用先前验证的问卷评估饮食依从性。饮食干预1个月后，两组的总体重和瘦体重均显著下降，但与ICD组相比，LCD组的下降更为显著（9.3±1.8 vs 6.2±1.7kg和6.6±0.4 vs 1.4±0.6kg，p<0.05），而ICD组的脂肪量下降更好（4.8±0.7 vs 2.7±0.8kg，p<0.05）。ICD组的平均ALT水平下降（77.5±41.7 vs 98.8±45.7，p<0.01），但LCD组未下降（81.2±50.6 vs 77.2±31.8，p=无显著差异），而两组的血液胆固醇、甘油三酯、高密度脂蛋白均显著下降。此外，在饮食干预期间，LCD组72%的患者ALT升高。ICD组的依从性指数远高于LCD组（85% vs 54%）。因此，与LCD相比，1个月的ICD可使大多数NASH患者的ALT活性降低，脂肪量损失更高，瘦体重损失更低，且依从性更好。
