Treatment of NAFLD with intermittent calorie restriction or low-carb high-fat diet – a randomised controlled trial

Apr 26, 2021JHEP reports : innovation in hepatology

Treating fatty liver disease with intermittent calorie restriction or low-carb high-fat diet: a controlled trial

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Abstract

Both the low-carb high-fat diet and the 5:2 diet resulted in a 7.2% and 6.1% reduction in liver fat, respectively, compared to a 3.6% reduction with standard care.

The low-carb high-fat diet (LCHF) and the 5:2 diet were more effective than standard care in reducing liver fat in patients with non-alcoholic fatty liver disease (NAFLD).
Weight loss was also greater with LCHF (-7.3 kg) and 5:2 diet (-7.4 kg) compared to standard care (-2.5 kg).
Improvement in liver stiffness was observed with the 5:2 diet and standard care, but not with the LCHF diet.
The 5:2 diet was associated with lower levels of LDL cholesterol and was better tolerated than the LCHF diet.
No significant differences in outcomes were found between the LCHF and 5:2 diets.

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BACKGROUND & AIMS: The first-line treatment for non-alcoholic fatty liver disease (NAFLD) is weight reduction. Several diets have been proposed, with various effects specifically on liver steatosis. This trial compared the effects of intermittent calorie restriction (the 5:2 diet) and a low-carb high-fat diet (LCHF) on reduction of hepatic steatosis.

METHODS: We conducted an open-label randomised controlled trial that included 74 patients with NAFLD randomised in a 1:1:1 ratio to 12 weeks' treatment with either a LCHF or 5:2 diet, or general lifestyle advice from a hepatologist (standard of care; SoC). The primary outcome was reduction of hepatic steatosis as measured by magnetic resonance spectroscopy. Secondary outcomes included transient elastography, insulin resistance, blood lipids, and anthropometrics.

RESULTS: The LCHF and 5:2 diets were both superior to SoC treatment in reducing steatosis (absolute reduction: LCHF: -7.2% [95% CI = -9.3 to -5.1], 5:2: -6.1% [95% CI = -8.1 to -4.2], SoC: -3.6% [95% CI = -5.8 to -1.5]) and body weight (LCHF: -7.3 kg [95% CI = -9.6 to -5.0]; 5:2: -7.4 kg [95% CI = -8.7 to -6.0]; SoC: -2.5 kg [95% CI =-3.5 to -1.5]. There was no difference between 5:2 and LCHF ( = 0.41 for steatosis and 0.78 for weight). Liver stiffness improved in the 5:2 and SoC but not in the LCHF group. The 5:2 diet was associated with reduced LDL levels and was tolerated to a higher degree than LCHF. p

CONCLUSIONS: The LCHF and 5:2 diets were more effective in reducing steatosis and body weight in patients with NAFLD than SoC, suggesting dietary advice can be tailored to meet individual preferences.

LAY SUMMARY: For a person with obesity who suffers from fatty liver, weight loss through diet can be an effective treatment to improve the condition of the liver. Many popular diets that are recommended for weight reduction, such as high-fat diets and diets based on intermittent fasting, have not had their effects on the liver directly evaluated. This study shows that both a low-carb high-fat and the 5:2 diet are effective in treating fatty liver caused by obesity.

CLINICAL TRIALS REGISTRATION: This study is registered at Clinicaltrials.gov (NCT03118310).

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Treatment of NAFLD with intermittent calorie restriction or low-carb high-fat diet – a randomised controlled trial

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