Published online May 7, 2017. doi: 10.3748/wjg.v23.i17.3150
Peer-review started: December 22, 2016
First decision: January 10, 2017
Revised: February 13, 2017
Accepted: April 13, 2017
Article in press: April 13, 2017
Published online: May 7, 2017
To determine the clinical effectiveness of nutritional counseling on reduction of non-alcoholic fatty liver disease (NAFLD) severity, weight loss, metabolic and anthropometric indexes and liver enzymes.
Forty-six adults with NAFLD received a 6-mo clinical and a dietary intervention (based on Mediterranean diet) carried out respectively by a gastroenterologist and a nutritionist with counseling license. The counseling process consisted of monthly meeting (about 45 min each). The effect of the treatment was evaluated monitoring liver enzymes, metabolic parameters, cardiovascular risk indexes, NAFLD severity [assessed by ultrasound (US)] and related indexes. All parameters were assessed at baseline. Biochemistry was also assessed at mid- and end-interventions and US was repeated at end-intervention.
The percentage of patients with steatosis grade equal or higher than 2 was reduced from 93% to 48% and steatosis regressed in 9 patients (20%). At the end of the treatment the end-point concerning the weight (i.e., a 7% weight reduction or achievement/maintenance of normal weight) was accomplished by 25 out of 46 patients (i.e., 54.3%). As far as the liver enzymes is concerned, all three liver enzymes significantly decrease during the treatment the normalization was particularly evident for the ALT enzyme (altered values reduced from 67% down to 11%). Several parameters, i.e., BMI, waist circumference, waist-to-hip ratio, AST, ALT, GGT, HDL, serum glucose, Tot-Chol/HDL, LDL/HDL, TG/HDL, AIP, HOMA, FLI, Kotronen index, VAI, NAFLD liver fat score and LAP, showed a significant improvement (P < 0.01) between baseline and end-treatment.
Outcomes of this study further strengthen the hypothesis that MedDiet and more active lifestyle can be considered a safe therapeutic approach for reducing risk and severity of NAFLD and related disease states. The proposed approach may be proposed as a valid and recommended approach for improving the clinical profile of NAFLD patients.
Core tip: Most recent advances in the management and treatment of Non-alcoholic fatty liver disease (NAFLD) show that a multifaceted approach is likely to achieve the best outcomes. Our study evaluates the effectiveness of 6-mo multidisciplinary approach jointly carried out by a gastroenterologist and a nutritionist with counseling license. The approach was effective on the reduction of NAFLD severity, weight, anthropometric indexes, cardiovascular disease risk factors and the normalization of metabolic index, as well as liver enzymes. This study strengthens the hypothesis that MedDiet and more active lifestyle can be considered a safe therapeutic approach for reducing severity of NAFLD.