Holmer Magnus, Lindqvist Catarina, Petersson Sven, Moshtaghi-Svensson John, Tillander Veronika, Brismar Torkel B, Hagström Hannes, Stål Per
Division of Hepatology, Department of Upper GI, Karolinska University Hospital, Stockholm, Sweden.
Unit of Gastroenterology and Hepatology, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden.
JHEP Rep. 2021 Feb 17;3(3):100256. doi: 10.1016/j.jhepr.2021.100256. eCollection 2021 Jun.
BACKGROUND & AIMS: The first-line treatment for non-alcoholic fatty liver disease (NAFLD) is weight reduction. Several diets have been proposed, with various effects specifically on liver steatosis. This trial compared the effects of intermittent calorie restriction (the 5:2 diet) and a low-carb high-fat diet (LCHF) on reduction of hepatic steatosis.
We conducted an open-label randomised controlled trial that included 74 patients with NAFLD randomised in a 1:1:1 ratio to 12 weeks' treatment with either a LCHF or 5:2 diet, or general lifestyle advice from a hepatologist (standard of care; SoC). The primary outcome was reduction of hepatic steatosis as measured by magnetic resonance spectroscopy. Secondary outcomes included transient elastography, insulin resistance, blood lipids, and anthropometrics.
The LCHF and 5:2 diets were both superior to SoC treatment in reducing steatosis (absolute reduction: LCHF: -7.2% [95% CI = -9.3 to -5.1], 5:2: -6.1% [95% CI = -8.1 to -4.2], SoC: -3.6% [95% CI = -5.8 to -1.5]) and body weight (LCHF: -7.3 kg [95% CI = -9.6 to -5.0]; 5:2: -7.4 kg [95% CI = -8.7 to -6.0]; SoC: -2.5 kg [95% CI =-3.5 to -1.5]. There was no difference between 5:2 and LCHF ( = 0.41 for steatosis and 0.78 for weight). Liver stiffness improved in the 5:2 and SoC but not in the LCHF group. The 5:2 diet was associated with reduced LDL levels and was tolerated to a higher degree than LCHF.
The LCHF and 5:2 diets were more effective in reducing steatosis and body weight in patients with NAFLD than SoC, suggesting dietary advice can be tailored to meet individual preferences.
For a person with obesity who suffers from fatty liver, weight loss through diet can be an effective treatment to improve the condition of the liver. Many popular diets that are recommended for weight reduction, such as high-fat diets and diets based on intermittent fasting, have not had their effects on the liver directly evaluated. This study shows that both a low-carb high-fat and the 5:2 diet are effective in treating fatty liver caused by obesity.
This study is registered at Clinicaltrials.gov (NCT03118310).
非酒精性脂肪性肝病（NAFLD）的一线治疗方法是减轻体重。人们提出了几种饮食方案，它们对肝脏脂肪变性有不同的影响。本试验比较了间歇性热量限制饮食（5:2饮食法）和低碳水高脂肪饮食（LCHF）对减轻肝脏脂肪变性的效果。
我们进行了一项开放标签的随机对照试验，纳入了74例NAFLD患者，按1:1:1的比例随机分为三组，分别接受为期12周的LCHF饮食、5:2饮食或肝病专家提供的一般生活方式建议（标准治疗；SoC）。主要结局是通过磁共振波谱法测量的肝脏脂肪变性减轻情况。次要结局包括瞬时弹性成像、胰岛素抵抗、血脂和人体测量指标。
LCHF饮食和5:2饮食在减轻脂肪变性方面均优于SoC治疗（绝对降低值：LCHF：-7.2%[95%CI=-9.3至-5.1]，5:2：-6.1%[95%CI=-8.1至-4.2]，SoC：-3.6%[95%CI=-5.8至-1.5]）和体重（LCHF：-7.3kg[95%CI=-9.6至-5.0]；5:2：-7.4kg[95%CI=-8.7至-6.0]；SoC：-2.5kg[95%CI=-3.5至-1.5]）。5:2饮食和LCHF之间没有差异（脂肪变性方面P=0.41，体重方面P=0.78）。5:2饮食组和SoC组的肝脏硬度有所改善，但LCHF组没有。5:2饮食与低密度脂蛋白水平降低有关，且耐受性高于LCHF。
对于NAFLD患者，LCHF饮食和5:2饮食在减轻脂肪变性和体重方面比SoC更有效，这表明饮食建议可以根据个人偏好进行调整。
对于患有脂肪肝的肥胖者，通过饮食减肥可以有效改善肝脏状况。许多推荐用于减肥的流行饮食方案，如高脂肪饮食和基于间歇性禁食的饮食，尚未直接评估其对肝脏的影响。本研究表明，低碳水高脂肪饮食和5:2饮食在治疗肥胖引起的脂肪肝方面均有效。
本研究已在Clinicaltrials.gov注册（NCT03118310）。
