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Treatment of NAFLD with intermittent calorie restriction or low-carb high-fat diet – a randomised controlled trial
- Source :
- JHEP Reports, Vol 3, Iss 3, Pp 100256-(2021), JHEP Reports
- Publication Year :
- 2021
- Publisher :
- Elsevier, 2021.
-
Abstract
- 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. Methods 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. Results 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 (p = 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. Conclusions 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. Lay summary 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. Clinical Trials Registration This study is registered at Clinicaltrials.gov (NCT03118310).<br />Graphical abstract<br />Highlights • Weight reduction is the only generally available treatment for NAFLD today. • High-fat diets, such as the LCHF, are controversial in treating NAFLD. • The 5:2 diet has become popular and is widely used to achieve weight loss. • In this RCT, both the LCHF and 5:2 diets were highly effective in treating NAFLD. • The 5:2 diet reduced LDL and liver stiffness and was tolerated to a higher degree.
- Subjects :
- OGTT, oral glucose tolerance test
Blood lipids
RC799-869
Gastroenterology
EoT, end of treatment
NNR, Nordic Nutrition Recommendations 2012
Waist–hip ratio
IR, insulin resistance
WHR, waist-to-hip ratio
Weight loss
Intermittent fasting
Immunology and Allergy
Low-carb-high fat (LCHF)
Fatty liver
ITT, intention-to-treat analysis
low-CHO, low-carbohydrate diet
Diseases of the digestive system. Gastroenterology
Diet treatment
5:2 diet
CT, computed tomography
LCHF, low-carb high-fat diet
Intermittent calorie restriction
CAP, controlled attenuation parameter
medicine.symptom
Research Article
ICR, intermittent calorie restriction
NAFLD, non-alcoholic fatty liver disease
medicine.medical_specialty
HOMA-IR, homeostatic model assessment for insulin resistance
NASH, non-alcoholic steatohepatitis
PP, per protocol analysis
E%, energy percent
Insulin resistance
ALT, alanine aminotransferase
Internal medicine
Internal Medicine
medicine
Obesity
ALA, α-linolenic acid
Hepatology
SoC, standard of care
business.industry
PUFAs, polyunsaturated fatty acids
MRS, magnetic resonance spectroscopy
T2DM, type 2 diabetes mellitus
medicine.disease
SFAs, saturated fatty acids
Steatosis
MUFA, monounsaturated fatty acids
Transient elastography
business
Subjects
Details
- Language :
- English
- ISSN :
- 25895559
- Volume :
- 3
- Issue :
- 3
- Database :
- OpenAIRE
- Journal :
- JHEP Reports
- Accession number :
- edsair.doi.dedup.....9cb0e3662e421d043c17f6286402ddeb