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  The Liver Meeting
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November 13 - 16 - 2021
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More Steatohepatitis Resolution With Low-Cal Mediterranean Diet Than With Low-Fat Diet
  AASLD, The Liver Meeting, November 12-15, 2021
Mark Mascolini
In people with nonalcoholic fatty liver disease (NAFLD), two low-calorie diets-a low-fat diet (LFD) and a Mediterranean diet (MD)-improved some markers of steatosis, steatohepatitis, and fibrosis [1]. But only the MD significantly improved steatohepatitis resolution rate, while significantly cutting aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT), total cholesterol, and AST-to-platelet ratio index (APRI).
A Spanish team from the University of Sevilla and other centers reminded AASLD attendees that a hypocaloric low-fat diet has been linked to resolution of steatosis and nonalcoholic steatohepatitis (NASH) while promoting fibrosis regression in people with histologically proven NASH [2]. An extra virgin olive oil-rich diet eased NASH induced by a high-fat Western diet in mice [3]. On the other hand, saturated fatty acids and trans fatty acids promote NAFLD.
To explore diet-induced liver changes further in people with histologically diagnosed NAFLD, the Spanish researchers conducted a multicenter study that randomized participants to one of two low-calorie diets (1500 kCal/day) for 3 months: LFD and MD. The LFD diet had 55% carbohydrates, 20% protein, and 25% fat; the MD had 45% carbohydrates, 20% protein, and 35% fat, including 46 g/day of olive oil and 4 nuts. All participants had nutritional counseling when the study began and at weeks 4, 8, and 12. The diet lasted 12 weeks.
Participants were 66 obese people not on a diet in the 6 months before entering this trial. They had biopsy-proved NAFLD in the 6 months before entering the trial. Thirty-one enrollees (47%) were women, age averaged 56 years, weight 94.7 kg, body mass index 34 kg/m2, waist circumference 114.1 cm, and body fat mass 35.6 kg. Among 31 people randomized to LFD, 16 (52%) were women; and among 35 randomized to MD, 15 (43%) were women. Weight, body mass index, waist circumference, and fat mass did not differ significantly between the two groups.
Certain metabolic parameters improved significantly with both diets, and some improved with one diet but not the other. Both groups had significant reductions in HbA1c (the diabetes metric), low-density lipoprotein (LDL) cholesterol, and alanine aminotransferase (ALT), Transient elastography gauging liver fibrosis and fatty liver index improved significantly in both groups.
Hepatic steatosis index improved only in the LFD group.
NASH resolved in 57% of people on the MD and did not resolve in the remaining 43% (P < 0.05). NASH resolved in only 24% in the LFD group. Only the MD group had a significant drop in total cholesterol, AST, and GGT. while APRI, which predicts liver fibrosis, improved significantly in the group on MD but not in the LFD group.
In both groups, improvements in steatosis, steatohepatitis, and fibrosis were associated with how much body weight dropped. Improvements in steatosis, steatohepatitis, and fibrosis depended on losing more than 6% of body weight.
1. Martín F, Berná G, López-Bermudo L, et al. Low hypocaloric Mediterranean diet versus standard diet in biopsy proven NAFLD patients. AASLD, The Liver Meeting, November 12-15, 2021. Parallel session 17: Clinical Advances in Alcohol-Associated Liver Disease.
2. Vilar-Gomez E, Martinez-Perez Y, Calzadilla-Bertot L, et al. Weight loss through lifestyle modification significantly reduces features of nonalcoholic steatohepatitis. Gastroenterology. 2015;149:367-78.e5. doi: 10.1053/j.gastro.2015.04.005.
3. Jurado-Ruiz E, Álvarez-Amor L, Varela LM, et al. Extra virgin olive oil diet intervention improves insulin resistance and islet performance in diet-induced diabetes in mice. Sci Rep. 2019;9:11311. doi: 10.1038/s41598-019-47904-z.