The Metabolic and Hepatic Impact of Two Personalized Dietary Strategies in Subjects with Obesity and Nonalcoholic Fatty Liver Disease: The Fatty Liver in Obesity (FLiO) Randomized Controlled Trial

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Abstract

The prevalence of nonalcoholic fatty liver disease (NAFLD) is increasing worldwide. NAFLD management is mainly focused on weight loss, but the optimal characteristics of the diet demand further investigation. This study aims to evaluate the effects of two personalized energy-restricted diets on the liver status in overweight or obese subjects with NAFLD after a 6 months follow-up. Ninety-eight individuals from the Fatty Liver in Obesity (FLiO) study were randomized into two groups and followed different energy-restricted diets. Subjects were evaluated at baseline and after 6 months. Diet, anthropometry, body composition, and biochemical parameters were evaluated. Liver assessment included ultrasonography, Magnetic Resonance Imaging, elastography, and determination of transaminases. Both dietary groups significantly improved their metabolic and hepatic markers after the intervention, with no significant differences between them. Multivariate regression models evidenced a relationship between weight loss, adherence to the Mediterranean Diet (MedDiet), and a decrease in liver fat content, predicting up to 40.9% of its variability after 6 months. Moreover, the antioxidant capacity of the diet was inversely associated with liver fat content. Participants in the group with a higher adherence to the MedDiet showed a greater reduction in body weight, total fat mass, and hepatic fat. These results support the benefit of energy-restricted diets, high adherence to the MedDiet, and high antioxidant capacity of the diet for the management of NAFLD in individuals with overweight or obesity.

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Endpoints and clinical trial design for nonalcoholic steatohepatitis.

Arun Sanyal, Elizabeth Brunt, David Kleiner … (2011)

Nonalcoholic fatty liver disease is a common cause of chronic liver disease in the general population. Nonalcoholic steatohepatitis (NASH), the aggressive form of nonalcoholic fatty liver disease, is associated with an increased risk of liver-related mortality and cardiovascular disease. At present, a liver biopsy is the only generally acceptable method for the diagnosis of NASH and assessment of its progression toward cirrhosis. Although several treatments have shown evidence of efficacy in clinical trials of varying design, there are no approved treatments for NASH, and published trials are often too divergent to allow meaningful comparisons. There is thus a lack of established noninvasive, point-of-care diagnostics and approved treatment on one hand and a substantial population burden of disease on the other. These provide the rationale for developing consensus on key endpoints and clinical trial design for NASH. This article summarizes the consensus arrived at a meeting of the American Association for the Study of Liver Diseases on the key endpoints and specific trial design issues that are germane for development of diagnostic biomarkers and treatment trials for NASH. Copyright © 2011 American Association for the Study of Liver Diseases.

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Liver stiffness in nonalcoholic fatty liver disease: A comparison of supersonic shear imaging, FibroScan, and ARFI with liver biopsy.

Christophe Cassinotto, Jerome Boursier, Victor de Lédinghen … (2016)

Nonalcoholic fatty liver disease (NAFLD) has become a major public health issue. The goal of this study was to assess the clinical use of liver stiffness measurement (LSM) evaluated by supersonic shear imaging (SSI), FibroScan, and acoustic radiation force impulse (ARFI) in a cohort of NAFLD patients who underwent liver biopsy. A total of 291 NAFLD patients were prospectively enrolled from November 2011 to February 2015 at 2 French university hospitals. LSM was assessed by SSI, FibroScan (M probe), and ARFI within two weeks prior to liver biopsy. Calculations of the area under the receiver operating curve (AUROC) were performed and compared for the staging of liver fibrosis. AUROC for SSI, FibroScan, and ARFI were 0.86, 0.82, and 0.77 for diagnoses of ≥F2; 0.89, 0.86, and 0.84 for ≥F3; and 0.88, 0.87, and 0.84 for F4, respectively. SSI had a higher accuracy than ARFI for diagnoses of significant fibrosis (≥F2) (P = 0.004). Clinical factors related to obesity such as body mass index ≥ 30 kg/m(2) , waist circumference ≥102 cm or increased parietal wall thickness were associated with LSM failures when using SSI or FibroScan and with unreliable results when using ARFI. In univariate analysis, FibroScan values were slightly correlated with NAFLD activity score and steatosis (R = 0.28 and 0.22, respectively), whereas SSI and ARFI were not; however, these components of NAFLD did not affect LSM results in multivariate analysis. The cutoff values for SSI and FibroScan for staging fibrosis with a sensitivity ≥90% were very close: 6.3/6.2 kPa for ≥F2, 8.3/8.2 kPa for ≥F3, and 10.5/9.5 kPa for F4.

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Mediterranean diet and cardiovascular health: Teachings of the PREDIMED study.

Emilio Ros, Miguel Martínez-González, Ramón Estruch … (2014)

The PREDIMED (Prevención con Dieta Mediterránea) study was designed to assess the long-term effects of the Mediterranean diet (MeDiet) without any energy restriction on incident cardiovascular disease (CVD) as a multicenter, randomized, primary prevention trial in individuals at high risk. Participants were randomly assigned to 3 diet groups: 1) MeDiet supplemented with extra-virgin olive oil (EVOO); 2) MeDiet supplemented with nuts; and 3) control diet (advice on a low-fat diet). After 4.8 y, 288 major CVD events occurred in 7447 participants; crude hazard ratios were 0.70 (95% CI: 0.53, 0.91) for the MeDiet + EVOO and 0.70 (95% CI: 0.53, 0.94) for the MeDiet + nuts compared with the control group. Respective hazard ratios for incident diabetes (273 cases) among 3541 participants without diabetes were 0.60 (95% CI: 0.43, 0.85) and 0.82 (95% CI: 0.61, 1.10) compared with the control group. After 1-y follow-up, participants in the MeDiet + nuts group showed a significant 13.7% reduction in prevalence of metabolic syndrome compared with reductions of 6.7% and 2.0% in the MeDiet + EVOO and control groups, respectively. Analyses of intermediate markers of cardiovascular risk demonstrated beneficial effects of the MeDiets on blood pressure, lipid profiles, lipoprotein particles, inflammation, oxidative stress, and carotid atherosclerosis, as well as on the expression of proatherogenic genes involved in vascular events and thrombosis. Nutritional genomics studies demonstrated interactions between a MeDiet and cyclooxygenase-2 (COX-2), interleukin-6 (IL-6), apolipoprotein A2 (APOA2), cholesteryl ester transfer protein plasma (CETP), and transcription factor 7-like 2 (TCF7L2) gene polymorphisms. The PREDIMED study results demonstrate that a high-unsaturated fat and antioxidant-rich dietary pattern such as the MeDiet is a useful tool in the prevention of CVD.

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Author and article information

Journal

Journal ID (nlm-ta): Nutrients

Journal ID (iso-abbrev): Nutrients

Journal ID (publisher-id): nutrients

Title: Nutrients

Publisher: MDPI

ISSN (Electronic): 2072-6643

Publication date (Electronic): 22 October 2019

Publication date Collection: October 2019

Volume: 11

Issue: 10

Electronic Location Identifier: 2543

Affiliations

[1 ]Department of Nutrition, Food Sciences and Physiology and Centre for Nutrition Research, Faculty of Pharmacy and Nutrition, University of Navarra, 31008 Pamplona, Spain; bmarin.1@ 123456alumni.unav.es (B.A.M.-A.); icgonzalez@ 123456unav.es (I.C.)

[2 ]Biomedical Research Centre Network in Physiopathology of Obesity and Nutrition (CIBERobn), Instituto de Salud Carlos III, 28029 Madrid, Spain; pep.tur@ 123456uib.es

[3 ]Navarra Institute for Health Research (IdiSNA), 31008 Pamplona, Spain; jimonreal@ 123456unav.es (J.I.M.); marelorz@ 123456unav.es (M.E.); iherrero@ 123456unav.es (J.I.H.); albenitob@ 123456unav.es (A.B.-B.); jquiroga@ 123456unav.es (J.Q.); ana.martinez.echeverria@ 123456cfnavarra.es (A.M.-E.); jurizota@ 123456cfnavarra.es (J.I.U.-O.); phuartem@ 123456cfnavarra.es (M.P.H.-M.)

[4 ]Clinical Chemistry Department, Clinica Universidad de Navarra 31008, Pamplona, Spain

[5 ]Department of Radiology, Clinica Universidad de Navarra, 31008 Pamplona, Spain

[6 ]Liver Unit, Clinica Universidad de Navarra 31008, Pamplona, Spain

[7 ]Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain

[8 ]Department of Internal Medicine, Clinica Universidad de Navarra, 31008 Pamplona, Spain

[9 ]Department of Gastroenterology, Complejo Hospitalario de Navarra, 31008 Pamplona, Spain

[10 ]Research Group on Community Nutrition and Oxidative Stress, University of Balearic Islands, 07122 Palma, Spain

Author notes

[* ]Correspondence: iabetego@ 123456unav.es (I.A.); jalfmtz@ 123456unav.es (J.A.M.); mazulet@ 123456unav.es (M.A.Z.); Tel.: +34-948-42-56-00 (ext. 806317) (M.A.Z.)

[†]

Equal contribution.

[‡]

Equal senior contribution.

Author information

Bertha Araceli Marin-Alejandre https://orcid.org/0000-0003-0741-8197

Itziar Abete https://orcid.org/0000-0002-6475-5387

José Ignacio Herrero https://orcid.org/0000-0002-9076-6717

Josep A. Tur https://orcid.org/0000-0002-6940-0761

J. Alfredo Martinez https://orcid.org/0000-0001-5218-6941

M. Angeles Zulet https://orcid.org/0000-0002-3926-0892

Article

Publisher ID: nutrients-11-02543

DOI: 10.3390/nu11102543

PMC ID: 6836315

PubMed ID: 31652512

SO-VID: 1a797858-ce0b-4b2c-9153-f2cf565d7d51

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Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

The Metabolic and Hepatic Impact of Two Personalized Dietary Strategies in Subjects with Obesity and Nonalcoholic Fatty Liver Disease: The Fatty Liver in Obesity (FLiO) Randomized Controlled Trial

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Karger: Nutrition and Dietetics

Most cited references 28

Endpoints and clinical trial design for nonalcoholic steatohepatitis.

Liver stiffness in nonalcoholic fatty liver disease: A comparison of supersonic shear imaging, FibroScan, and ARFI with liver biopsy.

Mediterranean diet and cardiovascular health: Teachings of the PREDIMED study.

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