生酮饮食可改善2型糖尿病患者的NAFLD，纤维化

StephenW

In the Journals
Nutrition Resource Center
Ketogenic diet improves NAFLD, fibrosis in patients with type 2 diabetes

Vilar-Gomez E, et al. BMJ Open. 2019;doi:10.1136/bmjopen-2018-023597.
February 28, 2019

Comprehensive continuous care intervention with a ketogenic diet significantly improved surrogate markers of nonalcoholic fatty liver disease and advanced fibrosis in patients with type 2 diabetes after 1 year, according to data published in BMJ Open.

Eduardo Vilar-Gomez, MD, PhD, from the Indiana University School of Medicine, and colleagues wrote that low-carbohydrate, high-fat and ketogenic diets have demonstrated significant weight loss effects in adults with overweight and obesity. In the short-term, these diets have also correlated with improved insulin sensitivity and glycemic control.

“Lower consumption of carbohydrate ... and ketogenic diets improve appetite control, satiety and/or reduce daily food intake helping to limit dietary energy consumption while maintaining patient-perceived vigor,” they wrote.

The researchers enrolled 262 patients to receive digitally supported comprehensive continuous care intervention (CCI) with a ketogenic diet and 87 controls who received usual care for 1 year. Most participants had suspicion of NAFLD (95%), were obese with a mean BMI of 39.5 kg/m2 (90%) and were taking medication for diabetes (84%).

At 1 year, patients in the CCI group demonstrated a reduction in suspected steatosis (95% to 75%) and an increase in the proportion of those without fibrosis (18% to 33%; P < .001), whereas there were no such changes in the usual care group. Patients in the CCI group were also more likely to achieve 5% or more weight loss (79% vs. 19.5%) and 10% or more weight loss (54% vs. 6%) than the usual care group.

Patients in the CCI group who achieved 10% or more weight loss had significant reductions in noninvasive markers of steatosis (P < .001), NAFLD-related fibrosis (P < .001), HbA1c (P < .001) and triglycerides (P < .001).

Changes in HbA1c (P = .03), weight (P = .004) and fasting glucose (P = .004) in the full cohort correlated with changes in alanine aminotransferase levels. HbA1c reduction of 0.5% or more at 1-year increased the odds for ALT normalization by 2.4-fold (95% CI, 1.09-5.3) and correlated with higher rates of ALT normalization regardless of whether a patient achieved 5% weight loss (P < .001).

The researchers noted no hepatic decompensation or ALT flares during the trial in either the CCI or usual care group.

“The influence of carbohydrate restriction and nutritional ketosis on liver histology of patients with biopsy-proven [nonalcoholic steatohepatitis] remains largely unexplored in the context of a well-designed randomized controlled trial,” Vilar-Gomez and colleagues wrote. “Medical interventions incorporating ketogenic diets appear effective for improving NAFLD and therefore may be an effective approach for reversing the natural history of NAFLD progression, although further studies are needed to confirm potential beneficial effect in patients with biopsy-confirmed NASH.” – by Talitha Bennett

Disclosure: Virtua Health funded this study. Vilar-Gomez reports no relevant financial disclosures. Please see the full study for all other authors’ relevant financial disclosures.

StephenW

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生酮饮食可改善2型糖尿病患者的NAFLD，纤维化

Vilar-Gomez E，et al。 BMJ公开赛。 2019; DOI：10.1136 / bmjopen-2018-023597。
2019年2月28日

根据BMJ公开发表的数据，1年后2型糖尿病患者的非酒精性脂肪性肝病和晚期纤维化的替代标志物显着改善了生酮饮食的全面持续护理干预。

来自印第安纳大学医学院的医学博士Eduardo Vilar-Gomez及其同事写道，低碳水化合物，高脂肪和生酮饮食对超重和肥胖的成年人有显着的减肥效果。在短期内，这些饮食也与改善的胰岛素敏感性和血糖控制相关。

他们写道：“降低碳水化合物的摄入量......和生酮饮食可以改善食欲控制，饱腹感和/或减少每日食物摄入量，从而有助于限制膳食能量消耗，同时保持患者感知的活力。”

研究人员招募了262名患者接受数字支持的综合持续护理干预（CCI）和生酮饮食，87名对照者接受常规护理1年。大多数参与者怀疑NAFLD（95％），肥胖，平均BMI为39.5 kg / m2（90％），并且正在服用糖尿病药物（84％）。

1年时，CCI组患者表现出疑似脂肪变性减少（95％~75％），无纤维化患者比例增加（18％~33％; P <.001），而没有常规护理组的变化。与常规治疗组相比，CCI组患者体重减轻5％或更多（79％对19.5％）和10％或更多体重减轻（54％对比6％）。

CCI组中体重减轻10％或以上的患者脂肪变性非侵袭性标志物（P <.001），NAFLD相关性纤维化（P <.001），HbA1c（P <.001）和甘油三酯（P）显着降低。 <.001）。

全组中HbA1c（P = .03），体重（P = .004）和空腹血糖（P = .004）的变化与丙氨酸氨基转移酶水平的变化相关。 HbA1c在1年时减少0.5％或更多，使ALT正常化的几率增加2.4倍（95％CI，1.09-5.3），并且与ALT正常化率较高相关，无论患者是否达到5％体重减轻（P <.001）。

研究人员指出，在CCI或常规治疗组的试验期间没有肝功能失代偿或ALT发作。

Vilar-Gomez及其同事写道：“在经过精心设计的随机对照试验中，碳水化合物限制和营养酮症对活检证实的[非酒精性脂肪性肝炎]患者肝脏组织学的影响仍未得到充分发现。” “结合生酮饮食的医疗干预似乎对改善NAFLD有效，因此可能是逆转NAFLD进展自然史的有效方法，尽管需要进一步的研究来确认活检确诊的NASH患者的潜在有益效果。” - 作者：Talitha Bennett

披露：Virtua Health资助了这项研究。 Vilar-Gomez报告没有相关的财务披露。有关所有其他作者的相关财务披露，请参阅完整的研究。