The Replacement of Only One Portion of Starchy Carbohydrates with Green Leafy Vegetables Regresses Mid and Advanced Stages of NAFLD: Results from a Prospective Pilot Study

Abstract

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.

Fruit and vegetable intake and the risk of non-alcoholic fatty liver disease: a meta-analysis of observational studies

“…This is all helpful in maintaining the energy balance of the liver, improving insulin sensitivity, and regulating liver lipid metabolism (34,35). Furthermore, dietary fiber also enhances satiety, thus promoting calorie restriction (36). Additionally, fruits and vegetables are rich in antioxidants, including vitamin C, vitamin E, beta-carotene, polyphenols, which neutralize free radicals and mitigate the detrimental effects of oxidative stress on the liver (37)(38)(39)(40)(41).…”

The Role of the Fatty Liver Index (FLI) in the Management of Non-Alcoholic Fatty Liver Disease: A Systematic Review

“…To demonstrate the benefits of a diet rich in vegetables and green fruits, as well as the advantages of carbohydrate restriction, De Nucci S et al [86] conducted a study on 40 patients, in which they exchanged a portion of high-carbohydrate food with a portion of green leafy vegetables over a three month period and assessed liver and metabolic markers of NAFLD. Before and at the end of the study, the 24 of the 40 patients who were able to complete the study were evaluated for the diagnosis of NAFLD by FLI, FAST score and FibroScan.…”