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地中海饮食和非酒精性脂肪性肝病患者
2011年11月21日 04:15 作者:施军平 访问量:1754
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The Mediterranean Diet: Improvement in Hepatic Steatosis and Insulin Sensitivity in Individuals with NAFLD
M. C. Ryan1, 2; C. Itsiopoulos2; G. Ward2; T. Thodis2; N. Trost3; P. V. Desmond1, 2; A. M. Wilson2
1. Gastroenterology, St VIncent's Hospital Melbourne, Fitzroy, VIC, Australia.
2. Medicine, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia.
3. Medical Imaging, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia.

 

Aim: Nonalcoholic fatty liver disease (NAFLD) affects up to 30% of the population and signifies increased risk of liver fibrosis and cirrhosis, type 2 diabetes and cardiovascular disease (CVD). Therapies are limited. Weight loss is of benefit but is difficult to maintain. We examined the effect of the Mediterranean Diet (MD), a diet high in omega-3 fatty acids, on steatosis and insulin sensitivity, without weight loss, using gold standard techniques.
Methods: Eleven non-diabetic subjects (5F/6M) with biopsy-proven NAFLD were recruited for a randomised, cross-over dietary intervention study. Each subject was randomised to commence with either the MD or the current standard advice, the National Heart Foundation Diet (NHFD), for 6 weeks. A 6-week washout period followed prior to commencement of the alternate diet. Each subject underwent a 3-hour (40 mU/kg/hr) hyperinsulinemic euglycemic clamp study to determine insulin sensitivity at baseline and at the end of each diet, as well as magnetic resonance imaging and 1H spectroscopy (MRI/MRS) of the liver. Endpoints were change in insulin sensitivity, change in steatosis, and changes in other CVD risk factors.
Results: A total of 22 diets were completed by eleven subjects. The baseline characteristics of the subjects commencing the two diets were not significantly different. They were abdominally obese (mean ± SEM: waist circumference 112±8cm [M], 96±7cm [F]); with elevated fasting concentrations of glucose (104.5±1.1mg/dL), insulin (18±6mU/L), triglycerides (318±100 mg/dL), ALT (58 ±11U/L) and γGT (59±15U/L). Insulin sensitivity at baseline was low (M=2.7±1.0 mg/kg/min-1). Compliance as measured by food records and serum carotenoids was adequate and not different between the two groups. Mean weight loss was not different between the two diets (p=0.22).
There was a significant improvement in insulin sensitivity with the MD (2.7±1.0 to 3.7±0.4 mg/kg/min-1, p=0.05), whereas after the NHFD there was no significant change (2.7±1.0 to 2.9±0.4 mg/kg/min-1, p=0.33). Hepatic steatosis declined significantly after the MD compared with the NHFD: measured by 1HMRS, there was a 38.4% reduction in hepatic fat (p=0.012, MD) versus 7% reduction (p=0.29, NHFD) [Fig1]. Hepatic fat fraction (HFF%) measured by MRI also declined significantly on the MD compared with the NHFD (p=0.008).
Conclusion: Even without weight loss, the MD reduces liver steatosis and improves insulin sensitivity in an insulin resistant population with NAFLD, compared to current dietary advice. Given the difficulty in achieving sustainable weight loss, this diet should be further investigated in subjects with NAFLD.

Ryan教授的报告来看,地中海饮食能明显减少非酒精性脂肪性肝病患者NAFLD)肝内脂肪肝,改善胰岛素敏感性,即使在体重没有明显下降的患者,这一结论在预期之中,因为已有大量研究报道地中海饮食不仅有益于心血管健康,减少糖尿病和肿瘤发生的风险,还可降低这些疾病的死亡率。所谓“地中海饮食”是泛指希腊、西班牙、法国和意大利南部等处于地中海沿岸的南欧各国,以蔬菜水果、鱼类、五谷杂粮、豆类和橄榄油为主的饮食风格,特点就是高纤维素、高维生素、低脂、低热量,含有大量天然抗氧化物质,如维生素E和多酚类以及单不饱和脂肪酸。显然,这种饮食结构非常适合NAFLD患者。

反观我国,当前NAFLD患者快速增长与所谓“西方饮食习惯”的高热量、高脂肪和高果糖饮食不无关系,尤其对青少年的危害值得重视。这些研究给了我们很好的提示,合理的饮食结构在NAFLD治疗中的重要作用,尤其是那些无法或者不愿通过运动来减重的患者,地中海饮食有助于NAFLD改善,但并非否认运动在NAFLD中的地位,行之有效的方法是将饮食和运动很好的结合起来。就我个人而言,地中海饮食对中国NAFLD患者肯定也会有效,但不太倾向照搬欧美研究的结果,建议在学习国外临床研究的同时,积极设计和开展一系列相关研究,从而明确中国患者的膳食结构和NAFLD发生和进展关系,提出一个适合中国患者习惯的饮食方案。

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