Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza University of Rome, 00161 Rome, Italy.
Department of Endocrinology and Diabetes, University Campus Bio-Medico of Rome, 00128 Rome, Italy.
Nutrients. 2020 Jul 18;12(7):2141. doi: 10.3390/nu12072141.
Non-alcoholic fatty liver disease (NAFLD) is a major cause of liver disease. Very low-calorie ketogenic diets (VLCKD) represent a feasible treatment as they induce profound weight loss and insulin resistance (IR) improvement. Despite the recognized benefits on NAFLD deriving from pharmacological administration of fibroblast growth factor 21 (FGF21), whose endogenous counterpart is a marker of liver injury, little is known about its physiology in humans.
To identify predictors of NAFLD improvement as reflected by the reduction of the non-invasive screening tool hepatic steatosis index (HSI) in obese patients undergoing a weight loss program.
Sixty-five obese patients underwent a 90-day dietary program consisting of a VLCKD followed by a hypocaloric low carbohydrate diet (LCD). Anthropometric parameters, body composition, and blood and urine chemistry were assessed.
Unlike most parameters improving mainly during the VLCKD, the deepest HSI change was observed after the LCD ( = 0.02 and < 0.0001, respectively). Baseline HOMA-IR and serum FGF21 were found to be positive (R = 0.414, = 0009) and negative (R = 0.364, = 0.04) independent predictors of HSI reduction, respectively.
We suggest that patients with IR and NAFLD derive greater benefit from a VLCKD, and we propose a possible role of human FGF21 in mediating NAFLD amelioration following nutritional manipulation.
非酒精性脂肪性肝病（NAFLD）是肝脏疾病的主要原因。极低卡路里生酮饮食（VLCKD）是一种可行的治疗方法，因为它能引起显著的体重减轻和改善胰岛素抵抗（IR）。尽管人们认识到成纤维细胞生长因子 21（FGF21）的药理学给药对 NAFLD 有好处，其内源性对应物是肝损伤的标志物，但对其在人体中的生理学作用知之甚少。
确定肥胖患者在接受减肥计划时，通过降低无创筛查工具肝脂肪指数（HSI）来改善非酒精性脂肪性肝病的预测因子。
65 名肥胖患者接受了为期 90 天的饮食计划，包括 VLCKD 和低热量低碳水化合物饮食（LCD）。评估了人体测量参数、身体成分以及血液和尿液化学。
与大多数主要在 VLCKD 期间改善的参数不同，HSI 的最大变化发生在 LCD 之后（= 0.02 和 < 0.0001，分别）。基线 HOMA-IR 和血清 FGF21 被发现是 HSI 降低的正（R = 0.414，= 0.0009）和负（R = 0.364，= 0.04）独立预测因子。
我们建议 IR 和 NAFLD 患者从 VLCKD 中获益更大，我们提出人类 FGF21 可能在营养干预后介导 NAFLD 改善方面发挥作用。
