Faculty of Medicine, Department of Medicine, Institute of Exercise and Occupational Medicine, Medical Center, University of Freiburg, Freiburg D-79106, Germany.
Department of Nutrition, Institute for Sports and Sports Science, University of Freiburg, Freiburg D-79106, Germany.
World J Gastroenterol. 2019 Mar 7;25(9):1116-1131. doi: 10.3748/wjg.v25.i9.1116.
Non-alcoholic steatohepatitis (NASH) has become one of the leading causes of liver disease in the western world. In obese patients weight reduction is recommended. Up to now there are no specific guidelines for weight loss in order to reduce hepatic fat content.
To investigate the effects of a 24-wk guided lifestyle intervention program compared to a meal replacement regimen based on soy protein.
Twenty-six subjects with NASH participated in a randomized single-center study. They were randomly assigned to either meal replacement group (MR-G) with soy-yogurt-honey preparation or to guided lifestyle change group (LC-G) with endurance activity and nutrition counselling. Serum alanine transaminase (ALT), aspartate transaminase (AST), lipid parameters, and adipokines were measured. Liver fat content and lipid composition were determined by magnetic resonance imaging and magnetic resonance spectroscopy. Body fat mass and lean body mass were assessed using Bod Pod device. Pre- and post-intervention monitoring of parameters was performed. Statistical analyses were conducted with SPSS software, results were expressed as median (interquartile range).
Twenty-two subjects (MR-G, = 11 and LC-G, = 11) completed the study (9 women, 13 men; age 52.1 (15.0) years, body mass index (BMI) 32.3 (3.3) kg/m²). In both groups a significant weight loss was achieved (MR-G: -6.4 (3.6) kg, < 0.01; LC-G: -9.1 (10.4) kg, < 0.01). BMI dropped in both groups (MR-G: -2.3 (1.5) kg/m, = 0.003; LC-G: -3.0 (3.4) kg/m, = 0.006). Internal fat and hepatic lipid content were markedly reduced in both groups in comparable amount. There was a strong correlation between reduction in liver fat and decrease in ALT. Likewise, both groups showed an improvement in glycemic control and lipid profile. Changes in adipokines, particularly in adiponectin and leptin were closely related to intrahepatic lipid changes.
Comprehensive lifestyle intervention and meal replacement regimen have comparable effects on body and liver fat, as well as decrease in markers of hepatic inflammation among NASH patients.
非酒精性脂肪性肝炎（NASH）已成为西方国家肝脏疾病的主要原因之一。在肥胖患者中，建议减轻体重。到目前为止，还没有专门针对降低肝脂肪含量的减肥指南。
调查 24 周指导的生活方式干预与基于大豆蛋白的代餐方案相比对 NASH 的影响。
26 名 NASH 患者参加了一项随机单中心研究。他们被随机分配到代餐组（MR-G），食用大豆酸奶蜂蜜制剂，或指导生活方式改变组（LC-G），进行耐力活动和营养咨询。检测血清丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）、血脂参数和脂肪因子。通过磁共振成像和磁共振波谱测量肝脂肪含量和脂质组成。使用 Bod Pod 设备评估体脂肪量和瘦体重。在干预前后监测参数。使用 SPSS 软件进行统计分析，结果表示为中位数（四分位数范围）。
22 名患者（MR-G， = 11；LC-G， = 11）完成了研究（9 名女性，13 名男性；年龄 52.1（15.0）岁，体重指数（BMI）32.3（3.3）kg/m²）。两组体重均显著减轻（MR-G：-6.4（3.6）kg， < 0.01；LC-G：-9.1（10.4）kg， < 0.01）。两组 BMI 均下降（MR-G：-2.3（1.5）kg/m， = 0.003；LC-G：-3.0（3.4）kg/m， = 0.006）。两组肝内脂肪和肝脂质含量均显著减少，减少量相当。肝脂肪减少与 ALT 降低之间存在很强的相关性。同样，两组患者的血糖控制和血脂谱均得到改善。脂肪因子的变化，特别是脂联素和瘦素的变化与肝内脂质变化密切相关。
综合生活方式干预和代餐方案对 NASH 患者的体脂和肝脂以及肝内炎症标志物的减少具有相当的效果。
