Research Group in Community Nutrition and Oxidative Stress, University Research Institute of Health Sciences (IUNICS), University of the Balearic Islands, 07122 Palma de Mallorca, Spain.
Health Research Institute of Balearic Islands (IdISBa), 07120 Palma de Mallorca, Spain.
Nutrients. 2021 Feb 15;13(2):629. doi: 10.3390/nu13020629.
To assess the efficacy of three lifestyle interventions on the reduction of liver fat content and metabolic syndrome (MetS), and whether such reductions would influence renal outcomes, we conducted a randomized controlled trial on 128 participants with MetS and non-alcoholic fatty liver disease (NAFLD), as well as available data on estimated glomerular filtration rate (eGFR) and urinary albumin-to-creatine ratio (UACR). Patients were randomized in 1:1:1 ratio to either Conventional Diet, Mediterranean diet (MD)-high meal frequency, and MD-physical activity groups. Each intervention aimed at reducing caloric intake by 25%-30% of baseline intake and increase energy expenditure by 400 kcal/70 kg. Patients attended regular visits and were followed-up for 6 months. Increased albuminuria was present in 13.3% of patients, while 32.8% showed hyperfiltration. UACR reduction was associated with higher levels of UACR at baseline but not with changes in liver fat. eGFR decreased in patients presenting hyperfiltration at baseline and was associated with reduction in liver fat and insulin resistance, as well as with increase in energy expenditure (R = 0.248, = 0.006). No significant differences were observed between the three treatment groups. In patients with NAFLD and MetS, energy expenditure significantly reduced hepatic fat accumulation and insulin resistance, which reduced glomerular hyperfiltration. Increased albuminuria was reduced, but it was not associated with reduced liver fat.
为了评估三种生活方式干预措施对降低肝脂肪含量和代谢综合征（MetS）的疗效，以及这些降低是否会影响肾脏结局，我们对 128 名患有 MetS 和非酒精性脂肪肝（NAFLD）的患者进行了一项随机对照试验，并对估计肾小球滤过率（eGFR）和尿白蛋白与肌酐比值（UACR）进行了可用数据评估。患者按照 1:1:1 的比例随机分为常规饮食组、地中海饮食（MD）高餐频组和 MD 运动组。每个干预组的目标都是将热量摄入减少基线摄入的 25%-30%，并增加 400 kcal/70 kg 的能量消耗。患者定期就诊并随访 6 个月。13.3%的患者出现白蛋白尿增加，32.8%的患者出现高滤过。UACR 的降低与基线时更高的 UACR 水平相关，但与肝脂肪的变化无关。在基线时存在高滤过的患者中，eGFR 降低，与肝脂肪和胰岛素抵抗的降低以及能量消耗的增加相关（R = 0.248，p = 0.006）。三个治疗组之间未观察到显著差异。在患有 NAFLD 和 MetS 的患者中，能量消耗显著减少了肝脂肪堆积和胰岛素抵抗，从而降低了肾小球高滤过。白蛋白尿增加减少，但与肝脂肪减少无关。
