A low-carbohydrate diet rapidly and dramatically reduces intrahepatic triglyceride content
A low-carbohydrate diet rapidly and dramatically reduces intrahepatic triglyceride content
复制标题
DOI：
10.1002/hep.21264
复制
发表时间：
2006-08-01
期刊：
影响因子：
13.5
通讯作者：
Burgess, Shawn C.
中科院分区：
文献类型：
--
作者：
Browning, Jeffrey D.;Davis, Jeannie;Burgess, Shawn C.
2005年11月，一名从16岁开始服用结合雌激素的42岁白人女性因评估持续6个月的右上腹疼痛而就诊。她肥胖并伴有混合性高脂血症，但没有糖尿病或空腹血糖受损的迹象。初步检查显示肝肿大（颅径：26厘米），血清丙氨酸转氨酶浓度升高（55 U/L）。病毒和自身免疫性血清学均为阴性，未发现遗传性或环境性（如乙醇）肝病病因。肝脏超声检查符合肝脏弥漫性脂肪浸润。通过肝脏质子磁共振波谱证实诊断为非酒精性脂肪性肝病（NAFLD），肝脏甘油三酯含量为44.6%（正常：5.5%）1（图1）。停用偶联雌激素不能缓解症状，由于患者的体重指数（32.2 kg/m2），开始饮食治疗以促进体重减轻。所选择的饮食是阿特金斯饮食法，强调选择健康的蛋白质和脂肪来源。在饮食的第7天，她是酮症患者，尿酮浓度为150mg /dL。这次就诊时进行了肝活检，显示泛小叶大泡性脂肪变性，无炎症活动或纤维化迹象。第14天，患者仍处于酮症状态，间接量热法呼吸商为0.72。体重指数降至30.9 kg/m2 (6.4 kg)，腹痛略有减轻。在这两周的时间里，饮食成分是54%的蛋白质，41%的脂肪，5%的碳水化合物，估计每天摄入的热量约为1000千卡。
During November of 2005, a 42-year-old white woman taking conjugated estrogen since age 16 was seen for evaluation of right upper quadrant pain of 6 months’ duration. She was obese with mixed hyperlipidemia but had no evidence of diabetes mellitus or impaired fasting glucose. Initial workup indicated hepatomegaly (craniocaudal dimension: 26 cm) with an increased serum alanine aminotransferase concentration (55 U/L). Viral and autoimmune serologies were negative, and no heritable or environmental (ie, ethanol) cause of liver disease was identified. Ultrasound examination of the liver was consistent with diffuse fatty infiltration of the liver. A diagnosis of non-alcoholic fatty liver disease (NAFLD) was confirmed by liver proton magnetic resonance spectroscopy, which demonstrated a liver triglyceride content of 44.6%(normal: 5.5%) 1 (Fig. 1). Discontinuation of conjugated estrogen was unsuccessful at relieving symptoms, and because of the patient’s body mass index (32.2 kg/m2), dietary therapy was initiated to promote weight loss. The diet chosen was the Atkins diet, emphasizing the selection of healthy sources of protein and fat. 2At day 7 of the diet, she was ketotic with a urinary ketone concentration of 150 mg/dL. Liver biopsy was performed at this visit and showed pan-lobular macrovesicular steatosis without evidence of inflammatory activity or fibrosis. At day 14 of the diet, she remained ketotic with a respiratory quotient of 0.72 by indirect calorimetry. Body mass index had fallen to 30.9 kg/m2 (6.4 kg) with a modest decrement in abdominal pain. Dietary composition over this 2-week period was 54% protein, 41% fat, and 5% carbohydrate with an estimated daily caloric intake of approximately 1,000 kcal. Saturated,