Low-carbohydrate, high-fat diet reduced fatty liver, improved type 2 diabetes control
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LONDON — A low-carbohydrate, high-fat diet significantly improved nonalcoholic fatty liver disease activity score and HbA1c more than a high-carbohydrate, low-fat diet in people with type 2 diabetes mellitus, according to a researcher here.
“If you have fat in the liver, you will benefit from eating fat,” Camilla Dalby Hansen, MD, from Odense University Hospital in Denmark, told attendees at the International Liver Congress. “This is the conclusion to our research study, which is the foremost extensive research study done on this particular diet in patients with type 2 diabetes and fatty liver disease.”
Although low carbohydrate-based dietary interventions have been found to improve glycemic control, the effect on NAFLD was previously unknown. To examine the effect of a low carb, high-fat diet on NAFLD, Hansen and colleagues randomized 185 patients to either a low-carb, high-fat or a “classic diabetes diet” consisting of high-carb, low-fat foods for 6 months. Both diets were non-calorie restricted.
“The special thing about these diets was that we told participants, ‘Please do not lose weight; eat until you’re full,’” Hansen said. “The classic diabetes diet has been the go-to diet for decades — it’s low in fats and high in whole grain products, such as oats, potatoes, vegetables. The low-carb, high-fat diet, on the contrary, is very high in fats, primarily healthy fats, such as avocado, olive oil, nuts and seeds, but also cheese, cream and high-fat dairy products.”
A positive outcome of the intervention would be determined by at least two points improvement in the NAFLD Activity Score (NAS), with at least one point improvement in either lobular inflammation or ballooning without worsening of fibrosis and on glycemic control.
Hansen and colleagues performed liver biopsies and measured HbA1c at baseline and after 6 months. They scored the biopsies in a blinded manner according to Nonalcoholic Steatohepatitis Clinical Research Network. The patients also received ongoing dietitian consultations, and compliance was regularly logged through an online food diary platform.
According to study results, the researchers observed no significant variation between the diet groups in terms of improvement of at least two points in NAS. However, Hansen and colleagues did report that more patients in the low-carb, high-fat group improved NAS with at least one point compared with the high-carb, low-fat group (70% vs. 49%; P = 0.028), and fewer patients in the low-carb, high-fat group experienced a worsening of NAS compared with the high-carb, low-fat group (1% vs. 23%; P < 0.001).
Additionally, patients in the low-carb, high-fat group demonstrated improved HbA1c (–9.5) compared with the high-carb, low-fat group (–3.4; P < 0.001) and lost considerably more weight (–5.7 kg vs. –1.8 kg; P < 0.001).
“We found that the low-carb, high-fat diet was very good in improving diabetes control,” Hansen said. “It reduced the fat in the liver, and even though patients were eating as many calories as they were used to, they lost 5.8% body weight.
“We find this very interesting because some of the problems with diets today is that it’s very difficult to sustain in the long-term, so we thought this might be easier to comply with if you’re full,” she added. “We hope that these results might give patients out there more options in the future, that they can pick for themselves what fits into their lifestyle.”
Perspective
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Stephen A. Harrison, MD, FAASLD
What this study tells me is, foundationally, the way we manage patients doesn’t change: It’s lifestyle medication. It’s eat less, run more. It’s exercise and try to lose weight. That is going to happen whether we put a patient on a drug or not, and maybe in the long-term we may not have people on these drugs forever. We get them benefit, we show that their disease is improved, and we offer them something that says they can maintain a healthier life by doing this.
I think the study is very informative. Yes, it’s a relatively small trial in the big scheme of things; the duration of the trial was relatively short. There was no change in fibrosis, but we wouldn’t really expect a change in fibrosis at 24 weeks. I think its provocative, and it gives healthy information about how to help manage our patients, from a lifestyle perspective, that we didn’t have prior to this meeting.
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Hansen C, et al. Abstract GS012. Presented at: International Liver Congress; June 22-26, 2022; London (hybrid meeting).
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