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Abstract：
Obesity and metabolic syndrome are linked to steatotic liver disease (SLD), the most common form of chronic liver disease. Lifestyle modifications and dieting are strategies that can prevent metabolic dysfunction-associated steatotic liver disease (MASLD). The very low-calorie ketogenic diet (VLCKD) is a helpful treatment for MASLD and has been recommended for people affected by obesity; we evaluated the effect of gender on steatosis and fibrosis in a cohort of 112 overweight or obese patients undergoing an eight-week treatment with a VLCKD. Differences between the genders in terms of anthropometric measures, body composition, and metabolic indicators were examined before, during, and after the nutritional intervention. At baseline, there were significant differences between men and women in terms of anthropometric parameters, blood pressure, Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), fasting insulin, hepatic markers, and lipid profile. Men had considerably higher levels of liver steatosis (measured by CAP) and liver stiffness (measured by E) under basal conditions than women. After the VLCKD, there were reductions in both genders of controlled attenuation parameter (CAP), body weight, body mass index (BMI), waist circumference, systolic and diastolic blood pressure, insulin resistance, fat mass (FM), free fat mass (FFM), and fasting blood glucose, insulin, glycated hemoglobin (HbA1c), triglycerides, total cholesterol, low-density lipoprotein (LDL) cholesterol, alanine transaminase (ALT), gamma-glutamyl transferase (γGT), and uric acid levels. Only in men, liver stiffness, aspartate aminotransferase (AST), creatinine, and C-reactive protein (CRP) levels significantly decreased. Moreover, men had significantly greater levels of liver steatosis: the male gender featured an increase of 23.96 points of the Fibroscan CAP. Men exhibited higher levels of steatosis and fibrosis than women, and these differences persist despite VLCKD. These gender-specific variations in steatosis and fibrosis levels could be caused by hormonal and metabolic factors, suggesting that different therapeutic strategies might be required depending on the gender.
摘要：
肥胖和代谢综合征与脂肪变性肝病（SLD）有关，慢性肝病最常见的形式。生活方式的改变和节食是可以预防代谢功能障碍相关的脂肪变性肝病（MASLD）的策略。极低卡路里生酮饮食（VLCKD）是MASLD的有益治疗方法，已被推荐用于肥胖患者；我们在112名超重或肥胖患者接受VLCKD治疗八周的队列中评估了性别对脂肪变性和纤维化的影响。性别在人体测量方面的差异，身体成分,之前检查了代谢指标，during,在营养干预之后。在基线,男性和女性在人体测量参数方面存在显著差异，血压,胰岛素抵抗的稳态模型评估（HOMA-IR），空腹胰岛素，肝标志物,和脂质分布。在基础条件下，男性的肝脏脂肪变性（通过CAP测量）和肝脏硬度（通过E测量）水平明显高于女性。在VLCKD之后,受控衰减参数(CAP)的两种性别都有降低，体重,体重指数（BMI），腰围,收缩压和舒张压,胰岛素抵抗，脂肪量（FM），游离脂肪量（FFM），和空腹血糖，胰岛素，糖化血红蛋白（HbA1c），甘油三酯，总胆固醇,低密度脂蛋白（LDL）胆固醇，丙氨酸转氨酶(ALT),γ-谷氨酰转移酶(γGT)，和尿酸水平。只有男人,肝脏硬度,天冬氨酸转氨酶（AST），肌酐,C反应蛋白（CRP）水平显著下降。此外，男性的肝脏脂肪变性水平明显较高:男性的FibroscanCAP增加23.96分.男性表现出的脂肪变性和纤维化水平高于女性，尽管VLCKD，这些差异仍然存在。脂肪变性和纤维化水平的这些性别特异性变化可能是由激素和代谢因素引起的。这表明根据性别可能需要不同的治疗策略。
