Effects of two personalized dietary strategies during a 2‐year intervention in subjects with nonalcoholic fatty liver disease: A randomized trial

Abstract

Background and objectives Nonalcoholic fatty liver disease (NAFLD) management is focused on lifestyle modifications, but long‐term maintenance is a challenge for many individuals. This study aimed to evaluate the long‐term effects of two personalized energy‐restricted dietary strategies on weight loss, metabolic and hepatic outcomes in overweight/obese subjects with NAFLD. Methods Ninety‐eight subjects from the Fatty Liver in Obesity (FLiO) study (NCT03183193) were randomly assigned to the American Heart Association (AHA) or the FLiO dietary group in a 2‐year controlled trial. Anthropometry, body composition (DXA), biochemical parameters and hepatic status (ultrasonography, Magnetic Resonance Imaging, and elastography) were assessed at baseline, 6, 12 and 24 months. Results Both the AHA and FLiO diets significantly reduced body weight at 6 (−9.7% vs −10.1%), 12 (−6.7% vs −9.6%), and 24 months (−4.8% vs −7.6%) with significant improvements in body composition, biochemical and liver determinations throughout the intervention. At the end of the follow‐up, the FLiO group showed a greater decrease in ALT, liver stiffness and Fatty Liver Index, among others, compared to AHA group, although these differences were attenuated when the analyses were adjusted by weight loss percentage. The FLiO group also showed a greater increase in adiponectin compared to AHA group. Conclusions The AHA and FLiO diets were able to improve body weight and body composition, as well as metabolic and hepatic status of participants with overweight/obesity and NAFLD within a 2‐year follow‐up. These findings show that both strategies are suitable alternatives for NAFLD management. However, the FLiO strategy may provide more persistent benefits in metabolic and hepatic parameters.

One size does not fit all; practical, personal tailoring of the diet to NAFLD patients

“…The Mediterranean‐like diet group showed a more significant decrease in body weight (−7.6% vs. −4.8%), ALT, liver stiffness, and liver fat at 24 months compared to the AHA group. These findings indicate that both strategies are suitable alternatives for NAFLD management, yet, the Mediterranean diet seems easier to maintain 35 …”

“…These findings indicate that both strategies are suitable alternatives for NAFLD management, yet, the Mediterranean diet seems easier to maintain. 35 An earlier study compared two high-protein diets rich in either animal protein or plant protein without calorie restriction for 6 weeks in subjects with T2DM and NAFLD. In fact, both diets were reduced-carb diets with the same macronutrient composition; E%: carbs 40/protein 30/fat 30, and both reduced liver fat similarly, independently of body weight.…”

Effect of progressive resistance training with weight loss compared with weight loss alone on the fatty liver index in older adults with type 2 diabetes: secondary analysis of a 12-month randomized controlled trial

“… 47 Collectively, these findings support previous research highlighting a strong relationship between the magnitude of change (loss) in weight (adiposity) and subsequent changes in FLI. 48 …”

Three Different Genetic Risk Scores Based on Fatty Liver Index, Magnetic Resonance Imaging and Lipidomic for a Nutrigenetic Personalized Management of NAFLD: The Fatty Liver in Obesity Study

“…The current randomized controlled trial was designed to compare the effectiveness of two weight loss dietary strategies with different nutritional features, anthropometric measurements, body composition and biochemical markers on hepatic health in overweight or obese subjects with ultrasonography-proven liver steatosis, as described elsewhere [32,33]. The intervention had a duration of 24 months and the participants were randomly assigned to the American Heart Association (AHA) or the Fatty Liver in Obesity (FLiO) group [34]. However, the present study was performed concerning the results after 6 months of followup.…”