A Prospective Study Of Dietary Intervention In Patients With Metabolic Dysfunction-associated Fatty Liver Disease

Background: Metabolic dysfunction-associated fatty liver disease(MAFLD)is affecting younger and younger people.Although diet-induced weight loss is the first-line treatment for patients with MAFLD,the therapeutic effect of high protein and low glycemic index dietary pattern on metabolism-related fatty liver disease remains to be studied.Objective: To evaluate whether dietary patterns of high protein and low glycemic index lead to improvement of fatty liver and significant weight loss in patients with MAFLD.Methods: Patients with MAFLD recruited in the health management center of Sichuan Provincial People’s Hospital from August 15,2020 to November 15,2020 were selected.Participants who met the inclusion and exclusion criteria were randomly assigned to intensive intervention group(IIG,n = 30)with high protein and low glycemic index diet,conventional intervention group(CIG,n = 33)with balanced diet and blank control group(CG,n = 31)with only health education.The changes of fatty liver,body weight and metabolism-related indexes in each group and between groups were compared after 12-week intervention.Results: There are 85 subjects completed the intervention,29 in the IIG,31 in the CIG and 25 in the CG.IIG compared with the baseline data,Fibrotouch index(CAP,LSM),physical index(body weight,BMI,WC),body composition index(body fat percentage,skeletal muscle,visceral fat,subcutaneous fat),blood pressure(SBP,DBP),hepatic function index(ALT,AST,GGT),blood lipid index(TG)and cardiovascular risk index(Hcy,Relative ba PWV),insulin sensitivity index(FINS,Hb A1 c,HOMA-IR)had significant differences(P < 0.05).There were no significant differences in TC,HDL-C,LDL-C,ABI and FPG(P > 0.05).Compared with the CIG,the physical index(body weight,BMI,WC),body composition index(body fat percentage,visceral fat,subcutaneous fat),blood pressure(DBP)and hepatic function index(GGT)of the IIG had significant statistical differences(P < 0.05).There were no significant differences in Fibrotouch indexes(CAP,LSM),body component indexes(skeletal muscle),blood pressure(SBP),hepatic function indexes(ALT,AST),blood lipid(TC,TG,HDL-C,LDL-C),cardiovascular risk indexes(Hcy,ABI,Relative ba PWV),fasting blood glucose and insulin sensitivity indexes(FPG,FINS,Hb A1 c,and HOB-IR)(P > 0.05).After 12 weeks of intervention,17.2% of the 29 subjects in the IIG completely eliminated fatty liver,and the patients with severe fatty liver decreased from 51.7% to 10.3%.Only 3.2%of the 31 subjects in the CIG completely eliminated fatty liver,and the patients with severe fatty liver decreased from 58.1% to 25.8%.Conclusions: Intensive intervention of high protein and low glycemic index diet can significantly improve subjects’ fatty liver status,and significantly reduced body weight of MAFLD patients compared to the conventional balanced diet,and the main weight loss component was body fat.This intensive dietary intervention can also lead to significant improvements in blood pressure,liver function,cardiovascular risk and insulin sensitivity in patients with MAFLD,which has potential long-term benefits for human health.