Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia.
School of Allied Health, Human Services and Sport, La Trobe University, Australia.
Liver Int. 2022 Jun;42(6):1308-1322. doi: 10.1111/liv.15264. Epub 2022 Apr 26.
Non-alcoholic fatty liver disease (NAFLD) is predominantly managed by lifestyle intervention, in the absence of effective pharmacotherapies. Mediterranean diet (MedDiet) is the recommended diet, albeit with limited evidence.
To compare an ad libitum MedDiet to low-fat diet (LFD) in patients with NAFLD for reducing intrahepatic lipids (IHL) by proton magnetic resonance spectroscopy ( H-MRS). Secondary outcomes include insulin resistance by homeostatic model of assessment (HOMA-IR), visceral fat by bioelectrical impedance analysis (BIA), liver stiffness measurement (LSM) and other metabolic outcomes.
In this parallel multicentre RCT, subjects were randomised (1:1) to MedDiet or LFD for 12 weeks.
Forty-two participants (25 females [60%], mean age 52.3 ± 12.6 years) were included, 23 randomised to LFD and 19 to MedDiet.; 39 completed the study. Following 12 weeks, there were no between-group differences. IHL improved significantly within the LFD group (-17% [log scale]; p = .02) but not within the MedDiet group (-8%, p = .069). HOMA-IR reduced in the LFD group (6.5 ± 5.6 to 5.5 ± 5.5, p < .01) but not in the MedDiet group (4.4 ± 3.2 to 3.9 ± 2.3, p = .07). No differences were found for LSM (MedDiet 7.8 ± 4.0 to 7.6 ± 5.2, p = .429; LFD 11.8 ± 14.3 to 10.8 ± 10.2 p = .99). Visceral fat reduced significantly in both groups; LFD (-76% [log scale], p = <.0005), MedDiet (-61%, p = <.0005).
There were no between-group differences for hepatic and metabolic outcomes when comparing MedDiet to LFD. LFD improved IHL and insulin resistance. Significant improvements in visceral fat were seen within both groups. This study highlights provision of dietary interventions in free-living adults with NAFLD is challenging.
非酒精性脂肪性肝病（NAFLD）主要通过生活方式干预进行治疗，目前尚无有效的药物治疗方法。地中海饮食（MedDiet）是推荐的饮食，但证据有限。
通过质子磁共振波谱（H-MRS）比较自由摄入的地中海饮食和低脂饮食（LFD）在治疗非酒精性脂肪性肝病患者减少肝内脂肪（IHL）的效果。次要结局包括通过稳态模型评估的胰岛素抵抗（HOMA-IR）、生物电阻抗分析（BIA）测量的内脏脂肪、肝硬度测量（LSM）和其他代谢结局。
在这项平行的多中心 RCT 中，将受试者随机（1:1）分配至地中海饮食或低脂饮食组，进行 12 周的治疗。
共纳入 42 名受试者（25 名女性[60%]，平均年龄 52.3±12.6 岁），23 名被分配至低脂饮食组，19 名被分配至地中海饮食组；39 名受试者完成了研究。经过 12 周的治疗，两组间无差异。低脂饮食组的 IHL 显著改善（-17%[对数刻度]；p=0.02），而地中海饮食组无改善（-8%，p=0.069）。低脂饮食组的 HOMA-IR 降低（6.5±5.6 至 5.5±5.5，p<.01），而地中海饮食组无变化（4.4±3.2 至 3.9±2.3，p=0.07）。两组的 LSM 无差异（地中海饮食组 7.8±4.0 至 7.6±5.2，p=0.429；低脂饮食组 11.8±14.3 至 10.8±10.2，p=0.99）。两组的内脏脂肪均显著减少；低脂饮食组（-76%[对数刻度]，p<.0005），地中海饮食组（-61%，p<.0005）。
比较地中海饮食和低脂饮食时，两组间肝和代谢结局无差异。低脂饮食可改善 IHL 和胰岛素抵抗。两组的内脏脂肪均有显著改善。本研究强调，为非酒精性脂肪性肝病的成年患者提供饮食干预具有挑战性。
