Hypocaloric high-protein diet improves clinical and biochemical markers in patients with nonalcoholic fatty liver disease (NAFLD)

Hypocaloric high-protein diet improves clinical and biochemical markers in patients with nonalcoholic fatty liver disease (NAFLD)
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DOI：
10.3305/nh.2014.29.1.7068
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发表时间：
2014-01-01
期刊：
Nutrición Hospitalaria
影响因子：
--
通讯作者：
Pinto Marques Souza de Oliveira, Claudia
Pinto Marques Souza de Oliveira, Claudia
中科院分区：
其他
文献类型：
--
作者：
Bezerra Duarte, Sebastião Mauro;Faintuch, Joel;Pinto Marques Souza de Oliveira, Claudia

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目的：为探讨低热量高蛋白饮食在非酒精性脂肪肝(NAFLD)患者中的作用，开展一项前瞻性临床研究。研究方法和步骤：分析48例稳定的NAFLD患者(接受低热量高蛋白饮食75天)介入前后的数据。变量包括人体测量学(体重指数/BMI和腰围/腰围/WC)、全身和节段生物阻抗分析和生化测试。结果：BMI、WC和体脂质量保持相对稳定(分别为-1.3%、-1.8%和-2.5%，无统计学意义)。总胆固醇、低密度脂蛋白和极低密度脂蛋白胆固醇、甘油三酯、谷草转氨酶/谷草转氨酶、碱性磷酸酶/碱性磷酸酶、空腹血糖和糖化血红蛋白/糖化血红蛋白降低(P&lt；0.05)。按BMI增加(22/48，45.8%)和降低(21/48，43.8%)进行分层，可得出ALT、AP和AST/ALT比值与体重减轻和肝脏受益之间的关联。体重增加的患者没有表现出任何变化。多变量评估证实，腰围、铁蛋白、三酰甘油和葡萄糖稳态标记物与肝酶的相关性最大。讨论：我们的结果与NAFLD治疗中限制热量的文献一致。建议NAFLD患者改变生活方式和减肥。欧洲指南也支持这一建议。结论：这是第一项研究表明，高蛋白、低热量饮食与NAFLD患者血脂、血糖稳态和肝酶的改善有关，与BMI下降或体脂减少无关。
Objective: To investigate the role of hypocaloric high-protein diet, a prospective clinical study was conducted in NAFLD patients.Research methods and procedures: Pre-versus post-interventional data were analyzed in 48 stable NAFLD patients (submitted to a hypocaloric high-protein diet during 75 days. Variables included anthropometrics (body mass index/ BMI and waist circumference/WC), whole-body and segmental bioimpedance analysis and biochemical tests. Diet compliance was assessed by interviews every two weeks.Results: BMI, WC and body fat mass remained relatively stable (-1.3%, -1.8% and -2.5% respectively, no significance). HDL- cholesterol increased (P < 0.05) whereas total, LDL and VLDL cholesterol, triglycerides, aspartate aminotransferase/AST, gamma glutamyltransferase/GGT, alkaline phosphatase/AP, fasting blood glucose and glycated hemoglobin/HbA1c decreased (P < 0.05). When patients were stratified according to increase (22/48, 45.8%) and decrease (21/48, 43.8%) of BMI, association between weight decrease and liver benefit could be elicited in such circumstances for ALT, AP and AST/ALT ratio. No change could be demonstrated in patients who gained weight. Multivariate assessment confirmed that waist circumference, ferritin, triacylglycerol, and markers of glucose homeostasis were the most relevant associated with liver enzymes.Discussion: Ours results are consistent with the literature of calorie restriction in the management of NAFLD. Changes in lifestyle and weight loss are recommended for NAFLD patients. European guidelines also support this recommendation.Conclusion: This is the first study that demonstrated that a high protein, hypocaloric diet were associated with improvement of lipid profile, glucose homeostasis and liver enzymes in NAFLD independent on BMI decrease or body fat mass reduction.