Nonalcoholic fatty liver disease (NAFLD) is a common and potentially serious form of chronic liver disease that occurs in patients who do not abuse alcohol. Present dietary recommendations for all Americans, including those with NAFLD, endorse a low-calorie, low-fat diet. However, little is known about the effect of diet composition on liver histopathology in patients with NAFLD. The aim of this study was to determine whether overall calorie intake and diet composition are associated with the severity of NAFLD histopathology. Seventy-four consecutive morbidly obese patients presenting for bariatric surgery from January 2001 to March 2002 were retrospectively reviewed. In addition to a standard surgical and psychological evaluation, all patients underwent a preoperative dietary evaluation using a standardized 24-hr food recall. Food intake was evaluated for total calories and macronutrients and compared to liver histopathology from biopsies routinely obtained during surgery. Associations with the severity of steatosis and the presence of inflammation or fibrosis were assessed separately using chi-square for categorical variables and ANOVA for continuous variables. Further, we conducted multiple logistic regression analyses for each histological outcome. There were no significant associations between either total caloric intake or protein intake and either steatosis, fibrosis, or inflammation. However, higher CHO intake was associated with significantly higher odds of inflammation, while higher fat intake was associated with significantly lower odds of inflammation. In conclusion, present dietary recommendations may worsen NAFLD histopathology.
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Clark JM, Brancati FL, Diehl AM: Nonalcoholic fatty liver disease. Gastroenterology 122:1649-1657, 2002
Pagano G,Pancini G, Musso G, et al.: Nonalcoholic steatohepatitis, insulin resistance, and metabolic syndrome: Further evidence of an etiologic association. Hepatology 35:367-372, 2002
Poonawala A, Nair SP, Thuluvath PJ: Prevalence of obesity and diabetes in patients with cryptogenic cirrhosis:Acase-control study. Hepatology 32:689-692, 2000
Wanless IR, Lentz JS: Fatty liver hepatitis (steatohepatitis) and obesity: An autopsy study with analysis of risk factors. Hepatology 12:1106-1110, 1990
Dixon JB, Bhathal PS, O'Brein PE: Nonalcoholic fatty liver disease: Predictors of nonalcoholic steatohepatitis and liver fibrosis in the severly obese. Gastroenterology 121:91-100, 2001
Mokdad A, Bowman BA, Ford ES, Vinicor F, Marks JS, Koplan JP: The continuing epidemics of obesity and diabetes in the United States. JAMA 286:1195-2000, 2001
NIH/NHLBI: Clinical Guidelines on the Idenification, Evaluation, and Treatment of Overweight Obesity in Adults. Washington, DC: U.S. Department of Health and Human Services, 1998
Sasena S, Johnson J, Ouiff SP, Elias E: Diet and exercise: Important first steps in the therapy of NASH. Hepatology 30:436A, 1999 (abstr)
Dietary Guidelines for Americans, 5th ed.: Home and Garden Bulletin 232:30.Washington, DC, U.S. Department of Agriculture/U.S. Department of Health and Human Services, 2000
Sweeney ME, Hill JO, Heller PA, Baney R, Dirolamo M: Severe vs moderate energy restriction with and without exercise in the treatment of obesity: Efficiency of weight loss. Am J Clin Nutr 57:127-134, 1993
Foster G, Wyatt H, Hill J, et al.: A randomized trial of a low-carbohydrate diet for obesity. N Engl J Med 348:2082-2090, 2003
Willett W, Leibel R: Dietary fat is not a major determinant of body fat. Am J Med 113(9B):47S-59S, 2002
Gifford KD: Dietary fats, eating guidelines, and public policy: History, critique, and recommendations. AmJ Med 113(9B):89S-106S, 2002
Stephenson J: Low-carb, low-fat diet gurus face off. JAMA 289(14):1767, 2003
Bravata DM, Sanders L, Huang J, et al.: Efficacy and safety of low-carbohydrate diets: A systematic review. JAMA289(14):1837-1850, 2003
Drenick E, Simmons F, Murphy J: Effect on hepatic morphology of treatment of obesity by fasting, reducing diets, and small-bowel bypass. N Engl J Med 282:829-834, 1970
Eriksson S, Eriksson K-F, Bondesson L: Nonalcoholic steatohepatitis in obesity: A reversible condition. Acta Med Scand 220:83-88, 1986
Rozental P, Biava C, Spencer H, Zimmerman HJ: Liver morphology and function tests in obesity and during total starvation. Am J Dig Dis 12:198-208, 1967
Ueno T, Sugawara H, Sujaku K, et al.: Therapeutic effects of re-stricted diet and exercise in obese patients with fatty liver. J Hepatol 27:103-107, 1997
Keefe EB, Adesman PW, Stenzel P, Palmer RM: Steatosis and cirrhosis in an obese diabetic. Resolution of fatty liver by fasting. Dig Dis Sci 32:441-445, 1987
Palmer M, Schaffner F: Effect of weight reduction on hepatic abnormalities in overweight patients. Gastroenterology 99:1408-1413, 1990
Sasena S, Johnson J, Ouiff SP, Elias E: Diet and exercise: Important first steps in the therapy of NASH. Hepatology 30:434A, 1999 (abstr)
Andersen T, Gluud C, Franzmann M, Christoffersen P: Hepatic effects of dietary weight loss in morbidly obese subjects. J Hepatol 12:224-229, 1991
Carter RL, Sharbough CO, Stapell CA. Reliability and Validity of the 24-hour recall. J Am Diet Assoc 79(5):542-547, 1981
Brunt EM, Janney CG, Di Bisceglie AM, Neuschwander-Tetri BA, Bacon BR: Nonalcholic steatohepatitis: A proposal for grading and staging the histological lesions. Am J Gastro 94:2467-2474, 1999
Matteoni CA, Younossi ZM, Gramlich T, Boparai N, Liu YC, McCullough AJ: Nonalcholic fatty liver disease:Aspectrum of clinical and pathological severity. Gastroenterology 116:1413-1419, 1999
Mezey E: Dietary fat and alcoholic liver disease. Hepatology 28(4):901-905, 1998
Lieber CS, De Carli LM: Quantitative relationship between amount of dietary fat and severity of alcoholic fatty liver. Am J Clin Nutr 23:474-478, 1970
Nanji AA, French SW: Dietary linoleic acid is required for the development of experimentally induced alcoholic liver injury. Life Sci 44:223-227, 1989
Nanji AA, Mendenhall CL, French SW: Beef fat prevents alcoholic liver disease in the rat. Alcohol Clin Exp Res 44:223-227, 1989
Nanji AA, Rahemtulla A, Daly T, Khwaja S, Miao L, Zhao S, Tahan SR: Cholesterol supplementation prevents necrosis and inflammation but enhances fibrosis in alcoholic liver disease in the rat. Hepatology 26:90-97, 1997
Novikoff PM: Fatty liver induced in Zucker "fatty" (ff) rats by a semisynthetic diet rich in sucrose. Proc Natl Acad Sci USA 74:3550-3554, 1977
Nehra V, Angulo P, Buchman AL, Lindor KD: Nutritional and metabolic considerations in the etiology of nonalcoholic steatohepatitis. Dig Dis Sci 46(11):2347-2352, 2001
Hellerstein MK, Christiansen M, Kaempfer S et al.: Measurement of de novo hepatic lipogenesis in humans using stable isotopes. J Clin Invest 87:1841-1852, 1991
Hellerstein MK, Neese RA: Mass isotopomer distribution analysis at 8 y: Theoretical, analytic, and experimental considerations. Am J Physiol 276:E1146-E1170, 1999
Schwarz JM, Linfoot P, Dare D, Aghajanian K: Hepatic de novo lipogenesis in normoinsulinemic and hyperinsulinemic subjects consuming high-fat, low-carbohydrate and low-fat, high carbohydrate isoenergenic diets. Am J Clin Nutr 77:43-50, 2003
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Solga, S., Alkhuraishe, A.R., Clark, J.M. et al. Dietary Composition and Nonalcoholic Fatty Liver Disease. Dig Dis Sci 49, 1578–1583 (2004). https://doi.org/10.1023/B:DDAS.0000043367.69470.b7
- hepatic inflammation