Effects of a low free sugar diet on the management of nonalcoholic fatty liver disease: a randomized clinical trial

Khodami, Banafshe; Hatami, Behzad; Yari, Zahra; Alavian, Seyyed Moayyed; Sadeghi, Amir; Varkaneh, Hamed Kord; Santos, Heitor O.; Hekmatdoost, Azita

doi:10.1038/s41430-022-01081-x

Cited by 22 publications

(21 citation statements)

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“…Dietary interventions remain an attractive strategy in the management of NAFLD and cardiometabolic problems, especially due to the improvement in indicators of adiposity, serum lipids, glycemic control, and blood pressure (8)(9)(10)(11)(12)(13). In recent years, IF regimens have gained massive popularity in the field of clinical nutrition as a method of energy restriction, possibly because patients are more likely to accept and adhere to lifestyle changes than taking pills daily (14)(15)(16)(17).…”

Section: Introductionmentioning

confidence: 99%

Effects of the 5:2 intermittent fasting diet on non-alcoholic fatty liver disease: A randomized controlled trial

et al. 2022

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Background and aimsDietary regimens are crucial in the management of non-alcoholic fatty liver disease (NAFLD). The effects of intermittent fasting (IF) have gained attention in this regard, but further research is warranted. Thus, we aimed to ascertain the overall effects of the 5:2 IF diet (5 days a week of normal food intake and 2 consecutive fasting days) in patients with NAFLD compared to a control group (usual diet).Methods and resultsA 12-week randomized controlled trial was performed to evaluate the effects of the 5:2 IF diet on anthropometric indices, body composition, liver indices, serum lipids, glucose metabolism, and inflammatory markers in patients with NAFLD. The IF group (n = 21) decreased body weight (86.65 ± 12.57–82.94 ± 11.60 kg), body mass index (30.42 ± 2.27–29.13 ± 1.95 kg/m2), waist circumference (103.52 ± 6.42–100.52 ± 5.64 cm), fat mass (26.64 ± 5.43–23.85 ± 5.85 kg), fibrosis (6.97 ± 1.94–5.58 ± 1.07 kPa), steatosis scores/CAP (313.09 ± 25.45–289.95 ± 22.36 dB/m), alanine aminotransferase (41.42 ± 20.98–28.38 ± 15.21 U/L), aspartate aminotransferase (34.19 ± 10.88–25.95 ± 7.26 U/L), triglycerides (171.23 ± 39.88–128.04 ± 34.88 mg/dl), high-sensitivity C-reactive protein (2.95 ± 0.62 −2.40 ± 0.64 mg/L), and cytokeratin-18 (1.32 ± 0.06–1.19 ± 0.05 ng/ml) values compared to the baseline and the end of the control group (n = 23)—p ≤ 0.05 were considered as significant. However, the intervention did not change the levels of high-density lipoprotein cholesterol, total cholesterol, low-density lipoprotein cholesterol, fasting blood sugar, insulin, HOMA-IR, and total antioxidant capacity.ConclusionAdhering to the 5:2 IF diet can reduce weight loss and related parameters (fat mass and anthropometric indicators of obesity), as well as hepatic steatosis, liver enzymes, triglycerides, and inflammatory biomarkers in patients with NAFLD.

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Section: Introductionmentioning

confidence: 99%

Effects of the 5:2 intermittent fasting diet on non-alcoholic fatty liver disease: A randomized controlled trial

et al. 2022

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“…Additionally, both LFD and LCD seemed to have report weight loss results in patient groups. Moreover, two studies reported fever impact of low free sugar diet on NAFLD in adolescent boys ( 41 ) and adults ( 42 ). Lastly, there remains insufficient evidence to deduce what duration, combination or intensity of treatment is most effective in these patients.…”

Section: Discussionmentioning

confidence: 99%

Low fat diet versus low carbohydrate diet for management of non-alcohol fatty liver disease: A systematic review

et al. 2022

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Although there is a consensus on beneficial effects of a low calorie diet in management of non-alcoholic fatty liver disease, the optimal composition of diet has not yet been elucidated. The aim of this review is to summarize the results of current randomized controlled trials evaluating the effects of low fat diet (LFD) vs. low carbohydrate diet (LCD) on NAFLD. This is a systematic review of all the available data reported in published clinical trials up to February 2022. The methodological quality of eligible studies was assessed, and data were presented aiming specific standard measurements. A total of 15 clinical trial studies were included in this systematic review. There is an overall lack of consensus on which dietary intervention is the most beneficial for NAFLD patients. There is also an overall lack of consensus on the definition of the different restrictive diets and the percentage of macronutrient restriction recommended. It seems that low calorie diets, regardless of their fat and carbohydrate composition, are efficient for liver enzyme reduction. Both LCD and LFD have similar effects on liver enzymes change; however, this improvement tends to be more marked in LFD. All calorie restrictive dietary interventions are beneficial for reducing weight, liver fat content and liver enzymes in individuals with NAFLD. Low fat diets seem to be markedly successful in reducing transaminase levels. Further research is needed to explore diet intensity, duration and long-term outcome.

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“…Dietary changes can be heterogeneous, and not all diets have the same metabolic effect. However, Khodami et al conducted a clinical trial revealing sugar-free diet can reduce the risk of steatosis and hepatic fibrosis in obese patients while decreasing inflammatory markers and triglyceride levels [85].…”

Section: Overlapping Management Approachesmentioning

confidence: 99%

“…There are multiple gaps/challenges facing patients, providers, researchers, and stakeholders within the healthcare system which contribute to poor NAFLD outcomes [8,85,[90][91][92][93][94][95][96][97][98][99][100][101][102][103].…”

Section: Nafld Care-related Challenges and Proposed Recommendationsmentioning

confidence: 99%

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Nonalcoholic Fatty Liver Disease: An Emerging Modern-Day Risk Factor for Cardiovascular Disease

Hassen¹,

Singh²,

Belete³

et al. 2022

Cureus

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Nonalcoholic fatty liver disease (NAFLD), also named metabolic dysfunction-associated fatty liver disease (MAFLD), is a progressive disease spectrum encompassing simple steatosis, nonalcoholic steatohepatitis (NASH), fibrosis, and cirrhosis. It is a clinically silent disease leading to multiple extra-hepatic complications/comorbidities. It is an independent risk factor for cardiovascular disease (CVD), increasing susceptibility to hypertension, atherosclerosis, arrhythmia, myocardial dysfunction, cardiac valve deformation, and venous thrombosis through putative mechanisms including systemic inflammation, endothelial dysfunction, oxidative stress, insulin resistance, and altered lipid metabolism. Eventually, it increases the CVD prevalence, incident, and fatality, contributing to a huge health care burden. In fact, CVD is becoming the leading cause of mortality among patients with NAFLD. Other cardiometabolic risk factors coexisting with NAFLD may also accelerate the synergistic development of CVD, which warrants assessment targeting hypertension, diabetes mellitus (DM), obesity, and dyslipidemia to be an integral part of NAFLD care. Monitoring metabolic biomarkers (glucose, glycosylated hemoglobin [HbA1c], insulin, lipids, and lipoproteins), cardiovascular (CV) risk scores (American College of Cardiology/American Heart Association [ACC/AHA] or Framingham), and subclinical atherosclerosis (coronary artery calcification [CAC], carotid intima-media thickness [CIMT], and carotid plaque) are recommended for risk prediction and reduction. There is no universally accepted treatment for NAFLD, and lifestyle changes with weight loss of at least 10% are the mainstay of management. Combination therapy of ezetimibe and statins have a cardioprotective effect and help reduce liver fat.Despite being an emerging risk factor for CVD and its rapidly increasing pattern affecting a quarter of the global population, NAFLD remains overlooked and undetected, unlike the other traditional risk factors. Hence, we conducted a comprehensive narrative review to shed more light on the importance of screening CVD in NAFLD patients. PubMed indexed relevant articles published from 2002 to 2022 (20 years) were searched in April 2022 using medical subject headings (MeSH) as "nonalcoholic fatty liver disease" [Mesh] AND "cardiovascular diseases" [Mesh]. Evidence from 40 observational studies, three clinical trials, one case series, 45 narrative reviews, four systematic reviews and meta-analyses, three systematic reviews, and one meta-analysis were summarized on the epidemiologic data, pathophysiologic mechanisms, clinical features, diagnostic modalities, overlapping management, perceived challenges and health literacy regarding the CVD risk attributed to NAFLD.

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Effects of a low free sugar diet on the management of nonalcoholic fatty liver disease: a randomized clinical trial

Cited by 22 publications

References 43 publications

Effects of the 5:2 intermittent fasting diet on non-alcoholic fatty liver disease: A randomized controlled trial

Effects of the 5:2 intermittent fasting diet on non-alcoholic fatty liver disease: A randomized controlled trial

Low fat diet versus low carbohydrate diet for management of non-alcohol fatty liver disease: A systematic review

Nonalcoholic Fatty Liver Disease: An Emerging Modern-Day Risk Factor for Cardiovascular Disease

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