Department of Nutrition, German University for Prevention and Health Care Management, 66123 Saarbrücken, Germany.
Nutrients. 2020 May 6;12(5):1316. doi: 10.3390/nu12051316.
Non-alcoholic fatty liver disease (NAFLD) has emerged as the most prevalent liver disease in industrialized countries. It is regarded as the hepatic manifestation of the metabolic syndrome (MetS) resulting from insulin resistance. Moreover, insulin resistance impairs glycogen synthesis, postprandially diverting a substantial amount of carbohydrates to the liver and storing them there as fat. NAFLD has far-reaching metabolic consequences involving glucose and lipoprotein metabolism disorders and risk of cardiovascular disease, the leading cause of death worldwide. No pharmaceutical options are currently approved for the treatment of NAFLD. Exercise training and dietary interventions remain the cornerstone of NAFLD treatment. Current international guidelines state that the primary goal of nutritional therapy is to reduce energy intake to achieve a 7%-10% reduction in body weight. Meal replacement therapy (formula diets) results in more pronounced weight loss compared to conventional calorie-restricted diets. However, studies have shown that body mass index (BMI) or weight reduction is not obligatory for decreasing hepatic fat content or to restore normal liver function. Recent studies have achieved significant reductions in liver fat with eucaloric diets and without weight loss through macronutrient modifications. Based on this evidence, an integrative nutritional therapeutic concept was formulated that combines the most effective nutrition approaches termed "liver-fasting." It involves the temporary use of a low calorie diet (total meal replacement with a specific high-protein, high-soluble fiber, lower-carbohydrate formula), followed by stepwise food reintroduction that implements a Mediterranean style low-carb diet as basic nutrition.
非酒精性脂肪性肝病（NAFLD）已成为工业化国家最常见的肝脏疾病。它被认为是胰岛素抵抗引起的代谢综合征（MetS）的肝脏表现。此外，胰岛素抵抗会损害糖原合成，从而在餐后将大量碳水化合物转移到肝脏并将其储存为脂肪。NAFLD 具有深远的代谢后果，涉及葡萄糖和脂蛋白代谢紊乱以及心血管疾病的风险，这是全球范围内导致死亡的主要原因。目前尚无药物可用于治疗 NAFLD。运动训练和饮食干预仍然是 NAFLD 治疗的基石。目前的国际指南指出，营养治疗的主要目标是减少能量摄入，以实现体重减轻 7%-10%。与传统的热量限制饮食相比，代餐疗法（配方饮食）可导致更明显的体重减轻。然而，研究表明，体重指数（BMI）或体重减轻并不是降低肝脂肪含量或恢复正常肝功能所必需的。最近的研究表明，通过宏量营养素的改变，可以在不减轻体重的情况下，通过摄入热量适中的饮食来显著减少肝脏脂肪。基于这一证据，提出了一种综合营养治疗概念，即“肝脏禁食”，它结合了最有效的营养方法，称为“肝脏禁食”。它涉及暂时使用低热量饮食（用特定的高蛋白、高可溶性纤维、低碳水化合物配方进行全餐替代），然后逐步重新引入食物，实施地中海式低碳水化合物饮食作为基本营养。
