Goss Amy M, Dowla Shima, Pendergrass May, Ashraf Ambika, Bolding Mark, Morrison Shannon, Amerson Alesha, Soleymani Taraneh, Gower Barbara
Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA.
School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Pediatr Obes. 2020 Jul;15(7):e12630. doi: 10.1111/ijpo.12630. Epub 2020 Mar 4.
Non-alcoholic fatty liver disease (NAFLD) has emerged as the most common form of liver disease among adolescents in industrialized countries. While lifestyle intervention remains the hallmark treatment for NAFLD, the most effective dietary strategy to reverse NAFLD in children is unknown.
The objective of this study was to determine the effects of a moderately CHO-restricted diet (CRD) vs fat-restricted diet (FRD) in adolescents with NAFLD on reduction in liver fat and insulin resistance.
Thirty-two children/adolescents (age 9-17) with obesity and NAFLD were randomized to a CRD (<25:25:>50% energy from CHO:protein:fat) or FRD (55:25:20) for 8 weeks. Caloric intakes were calculated to be weight maintaining. Change in hepatic lipid content was measured via magnetic resonance imaging, body composition via dual energy X ray absorptiometry and insulin resistance via a fasting blood sample.
Change in hepatic lipid did not differ with diet, but declined significantly (-6.0 ± 4.7%, P < .001 only within the CRD group. We found significantly greater decreases in insulin resistance (HOMA-IR, <.05), abdominal fat mass (P < .01) and body fat mass (P < .01) in response to the CRD vs FRD.
These findings suggest that consumption of a moderately CHO-restricted diet may result in decreased hepatic lipid as well as improvements in body composition and insulin resistance in adolescents with NAFLD even in the absence of intentional caloric restriction. Larger studies are needed to determine whether a CHO-restricted diet induces change in hepatic lipid independent of change in body fat.
非酒精性脂肪性肝病（NAFLD）已成为工业化国家青少年中最常见的肝病形式。虽然生活方式干预仍然是NAFLD的标志性治疗方法，但逆转儿童NAFLD最有效的饮食策略尚不清楚。
本研究的目的是确定中度碳水化合物限制饮食（CRD）与脂肪限制饮食（FRD）对患有NAFLD的青少年肝脏脂肪减少和胰岛素抵抗的影响。
32名患有肥胖症和NAFLD的儿童/青少年（9-17岁）被随机分配到CRD组（碳水化合物、蛋白质、脂肪的能量比例<25:25:>50%）或FRD组（55:25:20），为期8周。计算热量摄入以维持体重。通过磁共振成像测量肝脏脂质含量的变化，通过双能X线吸收法测量身体成分，通过空腹血样测量胰岛素抵抗。
肝脏脂质的变化在不同饮食组间无差异，但仅在CRD组中显著下降（-6.0±4.7%，P<.001）。我们发现，与FRD相比，CRD导致胰岛素抵抗（HOMA-IR，P<.05）、腹部脂肪量（P<.01）和身体脂肪量（P<.01）显著降低。
这些发现表明，即使在没有刻意限制热量的情况下，食用适度碳水化合物限制饮食可能会使患有NAFLD的青少年肝脏脂质减少，身体成分和胰岛素抵抗得到改善。需要进行更大规模的研究来确定碳水化合物限制饮食是否能在不依赖身体脂肪变化的情况下引起肝脏脂质变化。
