低脂与低碳水化合物饮食治疗非酒精性脂肪肝的meta分析

摘要/Abstract

摘要： 目的评价低脂饮食(LFD)与低碳水化合物饮食(LCD)干预非酒精性脂肪肝(NAFLD)的效果。方法利用PubMed、EMBASE、Medline、Cochrane library、web of science、中国知网(CNKI)、万方数据等数据库,检索自建库至 2019 年1月发表的有关于LFD与LCD干预NAFLD患者的临床随机对照试验,根据饮食干预中碳水化合物的比例将研究分为极低碳水化合物饮食组(VLCKD)、低碳水化合物饮食组(LCD)、中等碳水化合物饮食组(MCD)及高碳水化合物饮食组(HCD)并使用Stata11.0对所获数据进行meta分析。结果共纳入符合要求的文献11篇,共计420例NAFLD患者。分析结果显示:VLCKD组相对于LFD组,在改善NAFLD患者体质量、TC、TG、HDL、LDL、ALT、AST、GGT及肝脏脂肪含量方面差异无统计学意义(P>0.05);MCD饮食较LFD组可以降低NAFLD患者的TG水平(MD=-32.141,95% CI[-58.280,-6.001],P= 0.016),但在改善体质量、TC、HDL、LDL、ALT、AST、GGT及肝脂肪含量方面差异无统计学意义(P>0.05);HCD组相对于LFD组可以降低NAFLD患者的TC水平(MD=-0.59,95% CI[-0.979,-0.201],P= 0.003),而在改善体质量、TG、HDL、LDL、ALT、AST、GGT及肝脂肪含量方面差异无统计学意义(P>0.05)。结论目前有关LCD与LFD在NAFLD治疗上孰优孰劣的证据仍然缺乏,应该进行更多的调查和循证研究来评估LCD长期作用及稳定性。

关键词: 非酒精性脂肪肝, 低碳水化合物饮食, 低脂饮食, 疗效, Meta 分析

Abstract: Objective To evaluate the curative effect of the low-fat diet (LFD) and low-carbohydrate diet (LCD) on non-alcoholic fatty liver disease (NAFLD). Methods Databases including PubMed, Embase, Medline, Cochrane library, Web of Science, China National Knowledge Infrastructure and Wanfang Data were searched from inception to January 2019 for the randomized controlled trials on LFD or LCD in NAFLD therapy. Patients in studies included were divided into the very low-carbohydrate diet (VLCD) group, the LCD group, the medium-carbohydrate diet (MCD) group and the high-carbohydrate diet (HCD) group. And Stata11.0 was used to process the data. Results A total of 11 studies were included, comprising 420 NAFLD patients. There was no statistical difference in the body weight loss, total cholesterol (TC), triglyceride (TG), high density lipoprotein (HDL), low density lipoprotein (LDL), alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyltranspeptidase (GGT) and intrahepatic fat in patients with NAFLD between VLCD and LCD groups (P>0.05). Compared with the LFD group, the MCD group had lower TG in NAFLD patients (mean difference [MD] =-32.141, 95% confidence interval [CI] -58.280 ~ -6.001, P=0.016), while there were no significant differences in the body weight loss, TC, HDL, LDL, ALT, AST, GGT and intrahepatic fat (P>0.05). The HCD group had lower TC in patients with NAFLD (MD=-0.59, 95%CI -0.979 ~ -0.201, P=0.003), while there were no statistical differences in the body weight loss, TG, HDL, LDL, ALT, AST, GGT and intrahepatic fat (P>0.05). Conclusion There is still a lack of evidence for the superiority of LCD or LFD in the treatment of NAFLD. More evidence-based studies should be conducted to evaluate the long-term effects and stability of LCD.

Key words: Non-alcoholic fatty liver disease, Low-fat diet, Low-carbohydrate diet, Curative effect, Meta analysis

张玉亭, 黄一沁, 陈洁, 保志军. 低脂与低碳水化合物饮食治疗非酒精性脂肪肝的meta分析[J]. 肝脏, 2019, 24(10): 1119-1124.

ZHANG Yu-ting, HUANG Yi-qin, CHEN Jie, BAO Zhi-jun. Meta analysis of low-fat and low-carbohydrate diet for the treatment of non-alcoholic fatty liver disease[J]. Chinese Hepatolgy, 2019, 24(10): 1119-1124.

参考文献

[1] Chalasani N, Younossi Z, Lavine J E, et al. The diagnosis and management of non-alcoholic fatty liver disease: Practice Guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association. Hepatology, 2012, 55: 2005-2023.
[2] Katsagoni CN, Georgoulis M, Papatheodoridis GV, et al. Effects of lifestyle interventions on clinical characteristics of patients with non-alcoholic fatty liver disease: a meta-analysis. Metabolism, 2017. 68: 119-132.
[3] Higgins JPT, Altman DG. Chapter 8: assessing risk of bias in included studies. Cochrane handbook for systematic reviews of interventions. 2008: 1-52. .
[4] Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials, 1996, 17: 1-12.
[5] Noakes TD, Windt J. Evidence that supports the prescription of low-carbohydrate high-fat diets: a narrative review. Br J Sports Med, 2017, 51:133-139.
[6] Feinman R, Pogozelski W, Astrup A, et al. Dietary carbo-hydrate restriction as the first approach in diabetes management: critical review and evidence base. Nutrition, 2015, 31:1-13.
[7] De Luis DA, Aller R, Izaola O, et al. Effect of two different hypocaloric diets in transaminases and insulin resistance in nonalcoholic fatty liver disease and obese patients. Nutr Hosp, 2010, 25: 730-735.
[8] Arefhosseini SR, Ebrahimimameghani M, Naeimi AF, et al. Lifestyle modification through dietary intervention: health promotion of patients with non-alcoholic fatty liver disease. Health Promot Perspect, 2011. 1: 147-154.
[9] Browning JD, Baker JA, Rogers T, et al. Short-term weight loss and hepatic triglyceride reduction: evidence of a metabolic advantage with dietary carbohydrate restriction. Am J Clin Nutr, 2011. 93: 1048-1052.
[10] Eckard C, Cole R, Lockwood J, et al. Prospective histo-pathologic evaluation of lifestyle modification in nonalcoholic fatty liver disease: a randomized trial. Therap Adv Gastroenterol, 2013, 6: 249-259.
[11] Ryan MC, Itsiopoulos C, Thodis T, et al. The Mediterranean diet improves hepatic steatosis and insulin sensitivity in individuals with non-alcoholic fatty liver disease. J Hepatol, 2013. 59: 138-143.
[12] Utzschneider KM, Bayer-Carter JL, Arbuckle MD, et al. Beneficial effect of a weight-stable, low-fat/low-saturated fat/low-glycaemic index diet to reduce liver fat in older subjects. Br J Nutr, 2013, 109: 1096-1104.
[13] 徐军辉, 丁佑铭, 汪斌, 等. 低碳水化合物饮食对非酒精性脂肪肝临床指标的影响. 中华临床营养杂志, 2013, 21:287-291.
[14] Kani AH, Alavian SM, Esmaillzadeh A, et al. Effects of a novel therapeutic diet on liver enzymes and coagulating factors in patients with non-alcoholic fatty liver disease: a parallel randomized trial. Nutrition, 2014, 30: 814-821.
[15] Anna M, Anize VF, Seda S, et al. Effects of dietary fat and saturated fat content on liver fat and markers of oxidative stress in overweight/obese men and women under weight-stable conditions. Nutrients, 2014, 6: 4678-4690.
[16] Properzi C, O′Sullivan TA, Sherriff JL, et al. Ad libitum mediterranean and low-fat diets both significantly reduce hepatic steatosis: a randomized controlled trial. Hepatology, 2018. 68: 1741-1754.
[17] Jang EC, Jun DW, Lee SM, et al. Comparison of efficacy of low-carbohydrate and low-fat diet education programs in non-alcoholic fatty liver disease: a randomized controlled study. Hepatol Res, 2018. 48: E22-29.
[18] Taskinen MR, Söderlund S, Bogl LH, et al. Adverse effects of fructose on cardiometabolic risk factors and hepatic lipid metabolism in subjects with abdominal obesity. J Intern Med, 2017. 282: 187-201.