Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom.
Newcastle NIHR Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom.
Clin Transl Gastroenterol. 2020 Sep;11(9):e00231. doi: 10.14309/ctg.0000000000000231.
Nonalcoholic fatty liver disease (NAFLD) is the most common liver condition worldwide. A weight loss goal of ≥10% is the recommended treatment for NAFLD; however, only a minority of patients achieve this level of weight reduction with standard dietary approaches. This study aimed to determine whether a very low calorie diet (VLCD) is an acceptable and feasible therapy to achieve and maintain a ≥10% weight loss in patients with clinically significant NAFLD.
Patients with clinically significant NAFLD were recruited to a VLCD (∼800 kcal/d) intervention using meal replacement products. Anthropometrics, blood tests (liver and metabolic), liver stiffness, and cardiovascular disease risk were measured at baseline, post-VLCD, and at 9-month follow-up.
A total of 45 patients were approached of which 30 were enrolled 27 (90%) completed the VLCD intervention, and 20 (67%) were retained at 9-month follow-up. The VLCD was acceptable to patients and feasible to deliver. Intention-to-treat analysis found that 34% of patients achieved and sustained ≥10% weight loss, 51% achieved ≥7% weight loss, and 68% achieved ≥5% weight loss at 9-month follow-up. For those completing the VLCD, liver health (liver enzymes and liver stiffness), cardiovascular disease risk (blood pressure and QRISK2), metabolic health (fasting glucose, HbA1c, and insulin), and body composition significantly improved post-VLCD and was maintained at 9 months.
VLCD offers a feasible treatment option for some patients with NAFLD to enable a sustainable ≥10%, weight loss, which can improve liver health, cardiovascular risk, and quality of life in those completing the intervention.
非酒精性脂肪性肝病（NAFLD）是全球最常见的肝脏疾病。减重 10%是 NAFLD 的推荐治疗目标；然而，只有少数患者通过标准饮食方法达到这种减重水平。本研究旨在确定极低热量饮食（VLCD）是否是一种可接受且可行的治疗方法，以实现并维持临床显著 NAFLD 患者 ≥10%的体重减轻。
招募了患有临床显著 NAFLD 的患者，采用代餐产品进行 VLCD（约 800kcal/d）干预。在基线、VLCD 后和 9 个月随访时测量人体测量学、血液检查（肝脏和代谢）、肝脏硬度和心血管疾病风险。
共接触了 45 名患者，其中 30 名入组，27 名（90%）完成了 VLCD 干预，20 名（67%）在 9 个月随访时保留。VLCD 对患者是可接受的，也是可行的。意向治疗分析发现，34%的患者实现并维持 ≥10%的体重减轻，51%的患者实现 ≥7%的体重减轻，68%的患者在 9 个月随访时实现 ≥5%的体重减轻。对于完成 VLCD 的患者，肝脏健康（肝酶和肝脏硬度）、心血管疾病风险（血压和 QRISK2）、代谢健康（空腹血糖、HbA1c 和胰岛素）和身体成分在 VLCD 后显著改善，并在 9 个月时保持不变。
VLCD 为一些 NAFLD 患者提供了一种可行的治疗选择，使他们能够可持续地减轻 ≥10%的体重，从而改善肝脏健康、心血管风险和完成干预的患者的生活质量。
