Clinical Research On The Effect Of Dietary Nutrition Intervention On The Obese Type 2 Diabetes With Nonalcoholic Fatty Liver Disease

Background Obesity,Type 2 Diabetes Mellitus and Nonalcoholic Fatty Liver Disease relationship closely,is a common metabolic disease.According to the statistics of the International Diabetes Federation,the number of global diabetes patients has reached 425 million in 2017,among which the number of diabetes patients in China is 121 million.According to the epidemiological survey,more than 70% of T2 DM patients have NAFLD,and the incidence of NAFLD among obese patients is as high as 65-85%.Studies have shown that reasonable dietary nutrition intervention can restore metabolic injury in obese T2 DM patients by regulating intestinal microflora.Animal experiments have shown that probiotics can reduce insulin resistance and steatosis in animal models of NAFLD and have a protective effect on NAFLD.It is lack of dietary intervention on obesity T2 DM combined system of NAFLD clinical research,and the relationship between them is still unclear.Therefore,a special formula diet(whole grains,traditional Chinese medicinal foods,and prebiotics,WTP diet)was given to obese T2 DM with NAFLD patients,the clinical efficacy and practicability of WTP diet in obese T2 DM with NAFLD patients were systematically evaluated and compared with metformin.Objective 1.To evaluate the efficacy and practicality of WTP dietary intervention in obese T2 DM with NAFLD patients;2.To compare the clinical efficacy of WTP diet and metformin in obese T2 DM with NAFLD patients.Methods 1.The study was a parallel and randomized controlled trial.60 patients of BMI 25?kg/m2 with T2 DM and NAFLD were selected,from April 2017 to March 2018 in Department of endocrinology of Henan Provincial People's Hospital,according to the proportion of 2:1 were randomly divided into the WTP dietary intervention group(W group,40 cases)and metformin intervention group(U group,20 cases).The intervention period was 3 months,On the basis of routine diabetes diet guidance,WTP dietary intervention was used in group W,the U group was given metformin(0.85 g,once in the morning and once in the evening,orally).2.Hematological indicators such as TC,TG,HDL-C,LDL-C,ALT,AST,GGT,TBLL,and Hb A1 c,OGTT,BMI,FM% and other indicators were observed before and after intervention in patients,as well as the liver fat content before and after intervention and the differences between the two groups.3.Serum levels of IL-6,TNF-?and FGF 21 were measured by ELISA before and after the intervention.Results 1.General information of the subjects: A total of 60 obese T2 DM with NAFLD patients were included in the study,including 40 cases in the group W and 20 cases in the group U.Before the intervention,there was no significant difference between the two groups in FPG,Hb A1 c,HOMA-IR,HOMA-?,BMI,WHR,FM%,ALT,AST,GGT,TC,TG,and liver fat content.2.Glucose metabolism indexes:(1)Contrast between the two groups: FPG and 2h PG in group W were significantly decreased after intervention(P<0.05);FPG in group U decreased after baseline(P<0.05);Contrast between the two groups: there was no significant difference in the changes of FPG and 2h PG between the two groups.(2)Contrast between the two groups: FIns and 2h Ins in group W had a downward trend after intervention,but the difference was not statistically significant,the decrease of 2h Ins in group U after intervention was statistically significant(P< 0.05);there was no statistical difference between the two groups.(3)Contrast between the two groups: Hb A1 c in group W and group U showed a significant downward trend after intervention(P<0.05);contrast between groups: statistically significant difference(P<0.05).(4)Contrast between the two groups: HOMA-IR in W group and U group showed a significant downward trend after intervention(P<0.05);the difference between the two groups was not significant.3.Liver function indexes: Contrast between the two groups: ALT,AST,GGT,TBIL,TP,DBIL,ALP and LDH concentrations in group W were significantly decreased after intervention(P<0.05);the changes of LDH and ALB in the U group were significantly higher than those in other liver function indexes(P<0.05).4.Blood lipid related indexes: Contrast between the two groups: the levels of TG and Apo B100 in group W were significantly lower than those before intervention(P<0.05).There was no significant change in the blood lipids of the U group before and after the intervention.The contrast between the two groups was significantly lower in the W group and the LDL-C concentration in the W group(P<0.05).5.Obesity indexes: Contrast between the two groups: after the intervention,the body weight,BMI,waist circumference,WHR and FM% of the whole body of the W group were significantly reduced(P<0.05),but the downward trend of U group was not obvious.Contrast between the two groups: body weight,BMI,waist circumference,WHR,FM% and other obesity indicators in the W group showed a more significant decrease(P<0.05).6.MRI indexes: Contrast between the two groups: after the intervention,the liver fat content and volume index of the two groups were decreased significantly,with statistical difference(P<0.05).Contrast between the two groups: the decrease of liver fat content and volume index were more significant in the group W(P<0.05).7.Serological indexes: Contrast between the two groups: after the intervention,the level of TNF-?,FGF 21 in the group W decreased(P<0.05),and no significant downward trend in the group U.Contrast between the two groups: TNF-?,IL-6 level decreased more significantly in group W(P<0.05).Conclusion WTP dietary was superior to the metformin in improving the glucose and fat metabolism,and liver function,reducing insulin resistance and inflammatory factors,and reducing liver fat content in obese T2 DM with NAFLD patients,providing a reasonable and effective means of prevention and treatment for obese T2 DM with NAFLD patients.