1
|
Xiong Y, Shi X, Xiong X, Li S, Zhao H, Song H, Wang J, Zhang L, You S, Ji G, Liu B, Wu N. A systematic review and meta-analysis of randomized controlled trials: effects of mediterranean diet and low-fat diet on liver enzymes and liver fat content of NAFLD. Food Funct 2024. [PMID: 39076035 DOI: 10.1039/d4fo01461h] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2024]
Abstract
Background: Non-alcoholic fatty liver disease (NAFLD) has emerged as a leading cause of several chronic diseases, imposing a significant global economic burden. The Mediterranean diet (MD) and low-fat diet (LFD) are the two primary recommended dietary patterns that exhibit distinct positive effects on treating NAFLD. Objective: To investigate which of the two diets, MD and LFD, is more effective in the treatment of NAFLD. Methods: Randomized controlled trials (RCTs) up to April 2024 were searched for in PubMed, Web of Science, Medline, Scopus and Embase. Interventions included MD or LFD, with primary outcome measures being intrahepatic lipid, liver stiffness, triglycerides, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, alanine aminotransferase, gamma-glutamyl transferase, and homeostasis model assessment of insulin resistance. Secondary outcomes included weight, waist circumference, and body mass index. Use of random effects meta-analysis to assess outcomes of interest. Results: meta-analysis revealed no significant differences between MD and LFD in improving liver enzymes, liver fat, and related indices in NAFLD patients. Our findings provide compelling evidence for patients and healthcare professionals, allowing patients to choose a dietary pattern that aligns with their preferences and disease conditions. In summary, both MD and LFD can equivalently ameliorate NAFLD in the short term. Conclusions: Our results show that MD and LFD have similar therapeutic effects on liver enzymes and liver fat content in patients with NAFLD in the short term. Furthermore, our meta-analysis results have also opened up a new avenue of thought as to whether similar effects are achieved by alternating MD and LFD on alternate days.
Collapse
Affiliation(s)
- Yalan Xiong
- School of Public Health, Shanghai Innovation Center of Traditional Chinese Medicine Health Service, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China.
| | - Xinyu Shi
- School of Public Health, Shanghai Innovation Center of Traditional Chinese Medicine Health Service, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China.
| | - Xinying Xiong
- School of Public Health, Shanghai Innovation Center of Traditional Chinese Medicine Health Service, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China.
| | - Shenyu Li
- School of Public Health, Shanghai Innovation Center of Traditional Chinese Medicine Health Service, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China.
| | - Hanhua Zhao
- Department of Sport Science, College of Education, Zhejiang University, Hangzhou, China
| | - Hualing Song
- School of Public Health, Shanghai Innovation Center of Traditional Chinese Medicine Health Service, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China.
| | - Jianying Wang
- School of Public Health, Shanghai Innovation Center of Traditional Chinese Medicine Health Service, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China.
| | - Lei Zhang
- School of Public Health, Shanghai Innovation Center of Traditional Chinese Medicine Health Service, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China.
| | - Shengfu You
- Institute of Digestive Diseases, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Guang Ji
- School of Public Health, Shanghai Innovation Center of Traditional Chinese Medicine Health Service, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China.
- State Key Laboratory of Integration and Innovation of Classic Formula and Modern Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
- Institute of Digestive Diseases, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Baocheng Liu
- School of Public Health, Shanghai Innovation Center of Traditional Chinese Medicine Health Service, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China.
- State Key Laboratory of Integration and Innovation of Classic Formula and Modern Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Na Wu
- School of Public Health, Shanghai Innovation Center of Traditional Chinese Medicine Health Service, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China.
- State Key Laboratory of Integration and Innovation of Classic Formula and Modern Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| |
Collapse
|
2
|
Simonsson C, Nyman E, Gennemark P, Gustafsson P, Hotz I, Ekstedt M, Lundberg P, Cedersund G. A unified framework for prediction of liver steatosis dynamics in response to different diet and drug interventions. Clin Nutr 2024; 43:1532-1543. [PMID: 38754305 DOI: 10.1016/j.clnu.2024.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 04/11/2024] [Accepted: 05/07/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND & AIMS Non-alcoholic fatty liver disease (NAFLD) is a common metabolic disorder, characterized by the accumulation of excess fat in the liver, and is a driving factor for various severe liver diseases. These multi-factorial and multi-timescale changes are observed in different clinical studies, but these studies have not been integrated into a unified framework. In this study, we aim to present such a unified framework in the form of a dynamic mathematical model. METHODS For model training and validation, we collected data for dietary or drug-induced interventions aimed at reducing or increasing liver fat. The model was formulated using ordinary differential equations (ODEs) and the mathematical analysis, model simulation, model formulation and the model parameter estimation were all performed in MATLAB. RESULTS Our mathematical model describes accumulation of fat in the liver and predicts changes in lipid fluxes induced by both dietary and drug interventions. The model is validated using data from a wide range of drug and dietary intervention studies and can predict both short-term (days) and long-term (weeks) changes in liver fat. Importantly, the model computes the contribution of each individual lipid flux to the total liver fat dynamics. Furthermore, the model can be combined with an established bodyweight model, to simulate even longer scenarios (years), also including the effects of insulin resistance and body weight. To help prepare for corresponding eHealth applications, we also present a way to visualize the simulated changes, using dynamically changing lipid droplets, seen in images of liver biopsies. CONCLUSION In conclusion, we believe that the minimal model presented herein might be a useful tool for future applications, and to further integrate and understand data regarding changes in dietary and drug induced changes in ectopic TAG in the liver. With further development and validation, the minimal model could be used as a disease progression model for steatosis.
Collapse
Affiliation(s)
- Christian Simonsson
- Department of Biomedical Engineering, Linköping University, Linköping, Sweden; Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden; Department of Radiation Physics, Radiology, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Elin Nyman
- Department of Biomedical Engineering, Linköping University, Linköping, Sweden
| | - Peter Gennemark
- Department of Biomedical Engineering, Linköping University, Linköping, Sweden; Drug Metabolism and Pharmacokinetics, Research and Early Development, Cardiovascular, Renal and Metabolism (CVRM), BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Peter Gustafsson
- Department of Biomedical Engineering, Linköping University, Linköping, Sweden; Department of Media and Information Technology, Linköping University, Norrköping, Sweden
| | - Ingrid Hotz
- Department of Media and Information Technology, Linköping University, Norrköping, Sweden
| | - Mattias Ekstedt
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden; Department of Gastroenterology and Hepatology, Department of Health, Medicine and Caring Sciences, Linköping University, Sweden
| | - Peter Lundberg
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden; Department of Radiation Physics, Radiology, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Gunnar Cedersund
- Department of Biomedical Engineering, Linköping University, Linköping, Sweden; Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.
| |
Collapse
|
3
|
Erdem NB, Kahramanoğlu Aksoy E, Dikmen D, Uçar Baş K, Ağaçdiken A, İlhan Esgin M, Göktaş Z. Effects of low fat diet on inflammatory parameters in individuals with obesity/overweight and non-alcoholic fatty liver disease: A cross-sectional study. Medicine (Baltimore) 2024; 103:e37716. [PMID: 38608067 PMCID: PMC11018204 DOI: 10.1097/md.0000000000037716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 03/04/2024] [Indexed: 04/14/2024] Open
Abstract
Nonalcoholic fatty liver disease (NAFLD) is considered one of the most important causes of chronic liver disorders in the world. Dietary pattern is a modifiable risk factor that represents the main target for the prevention and treatment of NAFLD. The aim of this cross-sectional study was to assess the impact of low-fat diet on anthropometric measurements, biochemical, and inflammatory parameters in individuals with obesity/overweight and NAFLD. A total of 108 individuals (n = 59 males and n = 49 females) aged between 19 and 65 years participated in the 12-week weight loss program. Dietary treatment plans including low-fat diets were randomly prescribed for each individual. Anthropometric measurements were collected by a trained dietitian at baseline and 12-week follow-up. Blood samples were collected for each individual at baseline and 3rd month for biochemical measurements and enzyme-linked immunosorbent assay analysis for tumor necrosis factor-α (TNF-α), interleukin (IL)-6, fibroblast growth factor-21 (FGF-21), chemerin, and irisin levels in plasma. At the end of the study, body weight, body mass index, body fat % body fat mass (kg) reduced significantly in females and males (P < .05). Moreover, reductions in waist, hip, and neck circumferences were significant in both groups. Changes in alanine aminotransferase and aspartate aminotransferase levels were significant in 3rd month. After 3 months, reductions in TNF-α, IL-6, and FGF-21 levels were significant in individuals with obesity/overweight and NAFLD. While no significant change in chemerin and irisin levels was found. These results show that low-fat diet over a 12-week period led to improvements in both anthropometric measurements and biochemical parameters in individuals with obesity/overweight and NAFLD.
Collapse
Affiliation(s)
- Nur Bengü Erdem
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Evrim Kahramanoğlu Aksoy
- Department of Gastroenterology, University of Health Sciences, Keçiören Training and Research Hospital, Ankara, Turkey
| | - Derya Dikmen
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Kübra Uçar Baş
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Aslihan Ağaçdiken
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Merve İlhan Esgin
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Zeynep Göktaş
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| |
Collapse
|
4
|
Ali H, Shahzil M, Moond V, Shahzad M, Thandavaram A, Sehar A, Waseem H, Siddiqui T, Dahiya DS, Patel P, Tillmann H. Non-Pharmacological Approach to Diet and Exercise in Metabolic-Associated Fatty Liver Disease: Bridging the Gap between Research and Clinical Practice. J Pers Med 2024; 14:61. [PMID: 38248762 PMCID: PMC10817352 DOI: 10.3390/jpm14010061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 12/23/2023] [Accepted: 12/29/2023] [Indexed: 01/23/2024] Open
Abstract
This review provides a practical and comprehensive overview of non-pharmacological interventions for metabolic-associated fatty liver disease (MASLD), focusing on dietary and exercise strategies. It highlights the effectiveness of coffee consumption, intermittent fasting, and Mediterranean and ketogenic diets in improving metabolic and liver health. The review emphasizes the importance of combining aerobic and resistance training as a critical approach to reducing liver fat and increasing insulin sensitivity. Additionally, it discusses the synergy between diet and exercise in enhancing liver parameters and the role of gut microbiota in MASLD. The paper underscores the need for a holistic, individualized approach, integrating diet, exercise, gut health, and patient motivation. It also highlights the long-term benefits and minimal risks of lifestyle interventions compared to the side effects of pharmacological and surgical options. The review calls for personalized treatment strategies, continuous patient education, and further research to optimize therapeutic outcomes in MASLD management.
Collapse
Affiliation(s)
- Hassam Ali
- Department of Gastroenterology, Hepatology & Nutrition, ECU Health Medical Center, Brody School of Medicine, Greenville, NC 27834, USA
- Division of Gastroenterology, Hepatology & Nutrition, East Carolina University, Greenville, NC 27834, USA
| | - Muhammad Shahzil
- Department of Internal Medicine, Weiss Memorial Hospital, Chicago, IL 60640, USA;
| | - Vishali Moond
- Department of Internal Medicine, Saint Peter’s University Hospital, Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA
| | - Maria Shahzad
- Department of Internal Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Abhay Thandavaram
- Department of Internal Medicine, Kamineni Academy of Medical Sciences and Research Centre, Hyderabad 500068, Telangana, India
| | - Alina Sehar
- Department of Internal Medicine, University of Alabama at Birmingham-Huntsville Campus, Huntsville, AL 35801, USA
| | - Haniya Waseem
- Department of Internal Medicine, Advent Health Tampa, Tampa, FL 33613, USA
| | - Taha Siddiqui
- Department of Internal Medicine, Mather Hospital, Hofstra University Zucker School of Medicine, Port Jefferson, NY 11777, USA;
| | - Dushyant Singh Dahiya
- Division of Gastroenterology, Hepatology & Motility, The University of Kansas School of Medicine, Kansas City, KS 66103, USA
| | - Pratik Patel
- Department of Gastroenterology, Mather Hospital, Hofstra University Zucker School of Medicine, Port Jefferson, NY 11777, USA
| | - Hans Tillmann
- Department of Gastroenterology, Hepatology & Nutrition, ECU Health Medical Center, Brody School of Medicine, Greenville, NC 27834, USA
| |
Collapse
|
5
|
Kapoor N, Kalra S. Metabolic-Associated Fatty Liver Disease and Diabetes: A Double Whammy. Endocrinol Metab Clin North Am 2023; 52:469-484. [PMID: 37495338 DOI: 10.1016/j.ecl.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
Metabolic-associated fatty liver disease (MAFLD) is the hepatic manifestation of metabolic syndrome and affects about 55% of people living with diabetes. MAFLD has been shown to be an individual risk factor for cardiovascular disease and its associated mortality. Although common, MAFLD is often underdiagnosed and not given adequate attention during clinical visits. This review highlights the most recent literature available on the evaluation and management of MAFLD in the presence of diabetes. The more recently available antidiabetic agents including glucagon-like peptide-1 analogs and sodium-glucose cotransporter-2 inhibitors have been shown to effectively manage both diabetes and MAFLD.
Collapse
Affiliation(s)
- Nitin Kapoor
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, TN 632004, India; Non communicable disease unit, Baker Heart and Diabetes Institute, Melbourne, VIC 3004, Australia
| | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Endocrine Society of India (ESI), Bharti Hospital & B.R.I.D.E, Karnal, India; University Center for Research & Development, Chandigarh University, South Asian Federation of Endocrine Societies (SAFES), India.
| |
Collapse
|
6
|
Wang MY, Prabahar K, Găman MA, Zhang JL. Vitamin E supplementation in the treatment on nonalcoholic fatty liver disease (NAFLD): Evidence from an umbrella review of meta-analysis on randomized controlled trials. J Dig Dis 2023; 24:380-389. [PMID: 37503812 DOI: 10.1111/1751-2980.13210] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 06/11/2023] [Accepted: 07/25/2023] [Indexed: 07/29/2023]
Abstract
OBJECTIVE We conducted this umbrella review of meta-analysis on randomized controlled trials to clarify the effects of vitamin E administration on alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT), degrees of steatosis and fibrosis in patients with nonalcoholic fatty liver disease (NAFLD). METHODS PubMed, MEDLINE, SCOPUS, EMBASE, and Web of Science were searched to identify pertinent articles published up to June 2023. To calculate the overall effect size (ES) and confidence intervals (CI), random-effects model was used. RESULTS Six meta-analyses were included in the umbrella review. By pooling ES based on the random-effects model, we found that vitamin E supplementation significantly decreased ALT (ES -6.47, 95% CI -11.73 to -1.22, P = 0.01), AST (ES -5.35, 95% CI -9.78 to -0.93, P = 0.01), degrees of fibrosis (ES -0.24, 95% CI -0.36 to -0.12, P < 0.001) and steatosis (ES -0.67, 95% CI -0.88 to -0.45, P < 0.001) in NAFLD patients, but had no effect on GGT. In the subgroup analyses, we detected that fibrosis scores notably decreased when vitamin E dosage was >600 IU/day (ES -0.25, 95% CI -0.41 to -0.10, P = 0.002) and when the treatment duration was ≥12 months (ES -0.24, 95% CI -0.37 to -0.12, P < 0.001). CONCLUSION Vitamin E administration improves ALT, AST, fibrosis, and steatosis in NAFLD subjects. Fibrosis scores were significantly reduced when vitamin E dosage exceeded 600 IU/day or with a treatment duration of at least 12 months.
Collapse
Affiliation(s)
- Ming Yue Wang
- School of Pharmacy, Nantong University, Nantong, Jiangsu Province, China
- Department of Pharmacy, Yancheng Third People's Hospital, Yancheng, Jiangsu Province, China
| | - Kousalya Prabahar
- Department of Pharmacy Practice, Faculty of Pharmacy, University of Tabuk, Tabuk, Saudi Arabia
| | - Mihnea-Alexandru Găman
- Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- Center of Hematology and Bone Marrow Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - Jin Lin Zhang
- School of Pharmacy, Nantong University, Nantong, Jiangsu Province, China
- Department of Pharmacy, Tumor Hospital Affiliated to Nantong University, Nantong, Jiangsu Province, China
| |
Collapse
|
7
|
Jeeyavudeen MS, Khan SKA, Fouda S, Pappachan JM. Management of metabolic-associated fatty liver disease: The diabetology perspective. World J Gastroenterol 2023; 29:126-143. [PMID: 36683717 PMCID: PMC9850951 DOI: 10.3748/wjg.v29.i1.126] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/26/2022] [Accepted: 12/14/2022] [Indexed: 01/04/2023] Open
Abstract
The metabolic syndrome as a consequence of the obesity pandemic resulted in a substantial increase in the prevalence of metabolic-associated fatty live disease (MAFLD) and type 2 diabetes mellitus (T2DM). Because of the similarity in pathobiology shared between T2DM and MAFLD, both disorders coexist in many patients and may potentiate the disease-related outcomes with rapid progression and increased complications of the individual diseases. In fact, awareness about this coexistence and the risk of complications are often overlooked by both hepatologists and diabetologists. Management of these individual disorders in a patient should be addressed wholistically using an appropriate multidisciplinary team approach involving both the specialists and, when necessary, liaising with dieticians and surgeons. This comprehensive review is to compile the current evidence from a diabetologist's perspective on MAFLD and T2DM and to suggest optimal management strategies.
Collapse
Affiliation(s)
- Mohammad Sadiq Jeeyavudeen
- Department of Endocrinology and Metabolism, University Hospitals of Edinburgh, Edinburgh EH4 2XU, United Kingdom
| | - Shahanas K A Khan
- Department of Endocrinology and Metabolism, Lancashire Teaching Hospitals NHS Trust, Preston PR2 9HT, United Kingdom
| | - Sherouk Fouda
- School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC 3046, Australia
| | - Joseph M Pappachan
- Department of Endocrinology and Metabolism, Lancashire Teaching Hospitals NHS Trust, Preston PR2 9HT, United Kingdom
- Faculty of Science, Manchester Metropolitan University, Manchester M15 6BH, United Kingdom
- Faculty of Biology, University of Manchester, Manchester M13 9PL, United Kingdom
| |
Collapse
|