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Low-carb diet superior to low-fat in Korean patients with NAFLD

A low-carbohydrate diet program was more realistic and effective in reducing total energy intake and hepatic fat contents in Korean patients with nonalcoholic fatty liver disease compared with a low-fat diet, according to the results of a randomized trial.

“Ratio of fat energy consumption is less than 20% in most Asian cultures; therefore, for Korean NAFLD patients the conventional low-fat diet education might be both unrealistic and ineffective. Energy percent of carbohydrate is absolutely high in Asian compared to Western,” the researchers wrote. “[Our study] indicated that low carbohydrate education strategy was more effective not only [in] reducing body weight but also improving metabolic parameters among Koreans whose carbohydrates share a large proportion of total energy intake.”

Patients underwent dietary intervention for 8 weeks as part of either a low-fat diet education group or a low-carbohydrate diet education group. Each diet program included a face-to-face education session, three education sessions over the phone and a five-day diet diary collected before the program and after 8 weeks. Patients also responded to questionnaires regarding the difficulty of the program at 4, 6 and 8 weeks.

The researchers assigned 54patients to the low-fat diet, which was designed to take 25 kcal/kg of ideal body weight for weight reduction; dietary portions consisted of 60% to 70% carbohydrates, 15% to 20% proteins and 15% to 20% fats.

They further assigned 52 patients to the low-carbohydrate diet, which was also designed to take approximately 25 kcal/kg of ideal body weight for weight reduction. However, dietary portions consisted of 50% to 60% carbohydrates, 20% to 25% proteins and 20% to 25% fats.

In the low-fat group, compared with baseline, there was a significant reduction in weight (76.4 vs. 75.3 kg; P < .001), BMI (26.5 vs. 26.1 kg/m²; P = .002) and waist circumference (91.9 vs. 90 cm; P < .001).

In the low-carbohydrate group, compared with baseline, there was a significant reduction in weight (77.7 vs. 74.8 kg; P < .001), BMI (27.4 vs. 25.8 kg/m²; P = .011), waist circumference (93.3 vs. 90.3 cm; P < .001), systolic blood pressure (126.2 vs. 121.2 mmHg; P = .001), diastolic blood pressure (76.53 vs. 72.4 mmHg; P = .001), alanine aminotransferase (86.27 vs. 55.8 U/L; P < .001), aspartate aminotransferase (51.6 vs. 39.6 U/L; P < .001) and LDL cholesterol (119.8 vs. 112.7 mg/dL; P < .001).

Compared with the low-fat group, the low-carbohydrate group had a higher rate of ALT normalization (38.5% vs. 16.7%; P = 0.16) and a greater reduction of ALT levels (80.8% vs. 57.4%; P = .012). Only the low-carbohydrate group had significant decreases in total fat area (P = .001) and subcutaneous fat area (P = .002). The low-carbohydrate group did, however, have significant increases in liver Hounsfield unit (P = .05) and liver/spleen Hounsfield unit ratios (P = .015), which the low-fat group did not.

Regarding the difficulty questionnaire, the researchers wrote, “The 4th week evaluation showed that participants had a slightly higher difficulty in understanding the low-carbohydrate diet education compared to the low-fat diet education; however, the difficulty level assessed on the 6th and 8th weeks showed no difference. Moreover, on average, the compliance levels of both education groups were high and two groups showed no difference in the level of compliance.” – by Talitha Bennett

Disclosure: The researchers report no relevant financial disclosures.