NAFLD的黄金标准治疗是减肥和生活方式干预,这需要富含纤维,减少糖和饱和脂肪的饮食。纤维可能是有利于NAFLD患者,因为他们减少和减缓碳水化合物的吸收,脂质,和蛋白质,降低膳食的能量密度,增加他们的饱腹感。此外,蔬菜的多酚含量和其他生物活性化合物具有抗氧化和抗炎特性,可防止疾病进展。这项研究的目的是确定在三个月的时间内,富含绿叶蔬菜和适度限制碳水化合物摄入的饮食对NAFLD患者的影响。在筛查的40名患者中,24名患者完成了一项临床试验,其中包括将一份富含碳水化合物的食物换成一份绿叶蔬菜,评估NAFLD的肝脏和代谢标志物。所有患者均接受血常规检查,人体测量,生物电阻抗分析,纤维扫描,研究前和研究结束时的脂肪肝指数(FLI)评估。研究人群(n=24)的中位年龄为47.5(41.5-52.5)岁,主要包括女性(70.8%)。我们发现FLI,用于预测脂肪肝(73(33-89)与85(54-95),p<0.0001)和FAST得分,这是一个纤维扫描衍生的参数,用于识别处于进行性NASH风险的患者(0.03(0.02-0.09)与0.05(0.02-0.15),p=0.007),在改变饮食后都有所改善。BMI(33.3(28.6-37.3)与35.3(31.2-39.0),p<0.0001),WC(106.5(95.0-112.5)vs.110.0(103.0-124.0),p<0.0001),颈围(38.0(35.0-41.5)与39.5(38.0-42.5),p<0.0001),脂肪量(32.3(23.4-40.7)与37.9(27.7-43.5),p<0.0001),和细胞外水(17.3(15.2-20.8)vs.18.3(15.9-22.7),饮食三个月后,p=0.03)也均显着降低。与NAFLD相关的代谢参数降低:HbA1c(36.0(33.5-39.0)与38.0(34.0-40.5),p=0.01),甘油三酯(72(62-90)与90(64-132),p=0.03),和肝脏标志物AST(17(14-19)与18(15-27)p=0.01)和γGT(16(13-20)vs.16(14-27)p=0.02)。总之,在三个月的时间里,用一份蔬菜只替换一份淀粉碳水化合物就足以消退,至少在某种程度上,NAFLD的中期和晚期。这种对生活习惯的适度调整是很容易实现的。
The gold standard treatment for NAFLD is weight loss and lifestyle interventions, which require a diet enriched in fiber and reduced in sugars and saturated fats. Fibres may be advantageous for NAFLD patients since they reduce and slow the absorption of carbohydrates, lipids, and proteins, lowering the energy density of the meal and increasing their sense of satiety. Furthermore, the polyphenol content and other bioactive compounds of vegetables have antioxidant and anti-inflammatory properties preventing disease progression. The aim of this
study is to ascertain the effects of a diet enriched by green leafy vegetables and with a moderate restriction of carbohydrate intake in patients with NAFLD over a three month period. Among the forty patients screened, twenty four patients completed the clinical
trial consisting of swapping one portion of carbohydrate-rich food for one portion of green leafy vegetables, and liver and metabolic markers of NAFLD were evaluated. All patients underwent routine blood tests, anthropometric measurements, bioelectrical impedance analysis, fibroscan, and fatty liver index (FLI) evaluation before and at the end of the
study. The population under
study (n = 24) had a median age of 47.5 (41.5-52.5) years and included mainly women (70.8%). We found that FLI, which is used to predict fatty liver (73 (33-89) vs. 85 (54-95), p < 0.0001) and the FAST score, which is a fibroscan-derived parameter identifying patients at risk of progressive NASH (0.03 (0.02-0.09) vs. 0.05 (0.02-0.15), p = 0.007), were both improved after changes in diet. The BMI (33.3 (28.6-37.3) vs. 35.3 (31.2-39.0), p < 0.0001), WC (106.5 (95.0-112.5) vs. 110.0 (103.0-124.0), p < 0.0001), neck circumference (38.0 (35.0-41.5) vs. 39.5 (38.0-42.5), p < 0.0001), fat mass (32.3 (23.4-40.7) vs. 37.9 (27.7-43.5), p < 0.0001), and extracellular water (17.3 (15.2-20.8) vs. 18.3 (15.9-22.7), p = 0.03) were also all significantly lower after three months of diet. Metabolic parameters linked to NAFLD decreased: HbA1c (36.0 (33.5-39.0) vs. 38.0 (34.0-40.5), p = 0.01), triglycerides (72 (62-90) vs. 90 (64-132), p = 0.03), and the liver markers AST (17 (14-19) vs. 18 (15-27), p = 0.01) and γGT (16 (13-20) vs. 16 (14-27), p = 0.02). In conclusion, replacing only one portion of starchy carbohydrates with one portion of vegetables for a three month period is sufficient to regress, at least in part, both mid and advanced stages of NAFLD. This moderate adjustment of lifestyle habits is easily achievable.