The Metabolic and Hepatic Impact of Two Personalized Dietary Strategies in Subjects with Obesity and Nonalcoholic Fatty Liver Disease: The Fatty Liver in Obesity (FLiO) Randomized Controlled Trial.

Bertha Araceli Marin-Alejandre,María Pilar Huarte-Muniesa,Alberto Benito-Boillos,Juan Isidro Uriz-Otano,M Angeles Zulet,J Ignacio Monreal,J Alfredo Martinez,Mariana Elorz,Irene Cantero,Ana Martinez-Echeverria,Jorge Quiroga,José Ignacio Herrero,Josep A Tur,Itziar Abete

doi:10.3390/nu11102543

Abstract

The prevalence of nonalcoholic fatty liver disease (NAFLD) is increasing worldwide. NAFLD management is mainly focused on weight loss, but the optimal characteristics of the diet demand further investigation. This study aims to evaluate the effects of two personalized energy-restricted diets on the liver status in overweight or obese subjects with NAFLD after a 6 months follow-up. Ninety-eight individuals from the Fatty Liver in Obesity (FLiO) study were randomized into two groups and followed different energy-restricted diets. Subjects were evaluated at baseline and after 6 months. Diet, anthropometry, body composition, and biochemical parameters were evaluated. Liver assessment included ultrasonography, Magnetic Resonance Imaging, elastography, and determination of transaminases. Both dietary groups significantly improved their metabolic and hepatic markers after the intervention, with no significant differences between them. Multivariate regression models evidenced a relationship between weight loss, adherence to the Mediterranean Diet (MedDiet), and a decrease in liver fat content, predicting up to 40.9% of its variability after 6 months. Moreover, the antioxidant capacity of the diet was inversely associated with liver fat content. Participants in the group with a higher adherence to the MedDiet showed a greater reduction in body weight, total fat mass, and hepatic fat. These results support the benefit of energy-restricted diets, high adherence to the MedDiet, and high antioxidant capacity of the diet for the management of NAFLD in individuals with overweight or obesity.

Highlights

Nonalcoholic fatty liver disease (NAFLD) is defined as an excessive accumulation of hepatic fat in the absence of consumption of significant amounts of alcohol or other related causes of secondary hepatic steatosis [1,2]
Exclusion criteria included the presence of known liver disease other than NAFLD, ≥3 kg of body weight loss in the last 3 months, excessive alcohol consumption
Body Mass Index (BMI) and the rest of the anthropometrical measurements were significantly lowered in both dietary groups

Summary

Introduction

Nonalcoholic fatty liver disease (NAFLD) is defined as an excessive accumulation of hepatic fat in the absence of consumption of significant amounts of alcohol or other related causes of secondary hepatic steatosis [1,2]. The pathogenesis of NAFLD is complex, and multiple environmental and genetic factors are involved in its development and progression [5]. NAFLD is considered a liver disturbance and a multisystem disease that is related to type 2 diabetes mellitus, cardiovascular disease, and chronic kidney disease [9]. This condition can lead to nonalcoholic steatohepatitis (NASH), fibrosis, cirrhosis, and, hepatocellular carcinoma [10], which will be the leading cause for liver transplantation in the few years [11]

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