TY - JOUR
T1 - The beneficial effects of Mediterranean diet over low-fat diet may be mediated by decreasing hepatic fat content
AU - Gepner, Yftach
AU - Shelef, Ilan
AU - Komy, Oded
AU - Cohen, Noa
AU - Schwarzfuchs, Dan
AU - Bril, Nitzan
AU - Rein, Michal
AU - Serfaty, Dana
AU - Kenigsbuch, Shira
AU - Zelicha, Hila
AU - Yaskolka Meir, Anat
AU - Tene, Lilac
AU - Bilitzky, Avital
AU - Tsaban, Gal
AU - Chassidim, Yoash
AU - Sarusy, Benjamin
AU - Ceglarek, Uta
AU - Thiery, Joachim
AU - Stumvoll, Michael
AU - Blüher, Matthias
AU - Stampfer, Meir J.
AU - Rudich, Assaf
AU - Shai, Iris
N1 - Publisher Copyright: © 2019 European Association for the Study of the Liver
PY - 2019/8/1
Y1 - 2019/8/1
N2 - Background & Aim: It is unclear if a reduction in hepatic fat content (HFC) is a major mediator of the cardiometabolic benefit of lifestyle intervention, and whether it has prognostic significance beyond the loss of visceral adipose tissue (VAT). In the present sub-study, we hypothesized that HFC loss in response to dietary interventions induces specific beneficial effects independently of VAT changes. Methods: In an 18-month weight-loss trial, 278 participants with abdominal obesity/dyslipidemia were randomized to low-fat (LF) or Mediterranean/low-carbohydrate (MED/LC + 28 g walnuts/day) diets with/without moderate physical activity. HFC and abdominal fat-depots were measured using magnetic resonance imaging at baseline, after 6 (sub-study, n = 158) and 18 months. Results: Of 278 participants (mean HFC 10.2% [range: 0.01%–50.4%]), the retention rate was 86.3%. The %HFC substantially decreased after 6 months (−6.6% absolute units [−41% relatively]) and 18 months (−4.0% absolute units [−29% relatively]; p <0.001 vs. baseline). Reductions of HFC were associated with decreases in VAT beyond weight loss. After controlling for VAT loss, decreased %HFC remained independently associated with reductions in serum gamma glutamyltransferase and alanine aminotransferase, circulating chemerin, and glycated hemoglobin (p <0.05). While the reduction in HFC was similar between physical activity groups, MED/LC induced a greater %HFC decrease (p = 0.036) and greater improvements in cardiometabolic risk parameters (p <0.05) than the LF diet, even after controlling for VAT changes. Yet, the greater improvements in cardiometabolic risk parameters induced by MED/LC were all markedly attenuated when controlling for HFC changes. Conclusions: %HFC is substantially reduced by diet-induced moderate weight loss and is more effectively reduced by the MED/LC diet than the LF diet, independently of VAT changes. The beneficial effects of the MED/LC diet on specific cardiometabolic parameters appear to be mediated more by decreases in %HFC than VAT loss. Lay summary: High hepatic fat content is associated with metabolic syndrome, type 2 diabetes mellitus, and coronary heart disease. In the CENTRAL 18-month intervention trial, a Mediterranean/low-carbohydrate diet induced a greater decrease in hepatic fat content than a low-fat diet, conferring beneficial health effects that were beyond the favorable effects of visceral fat loss. ClinicalTrials.gov Identifier: NCT01530724.
AB - Background & Aim: It is unclear if a reduction in hepatic fat content (HFC) is a major mediator of the cardiometabolic benefit of lifestyle intervention, and whether it has prognostic significance beyond the loss of visceral adipose tissue (VAT). In the present sub-study, we hypothesized that HFC loss in response to dietary interventions induces specific beneficial effects independently of VAT changes. Methods: In an 18-month weight-loss trial, 278 participants with abdominal obesity/dyslipidemia were randomized to low-fat (LF) or Mediterranean/low-carbohydrate (MED/LC + 28 g walnuts/day) diets with/without moderate physical activity. HFC and abdominal fat-depots were measured using magnetic resonance imaging at baseline, after 6 (sub-study, n = 158) and 18 months. Results: Of 278 participants (mean HFC 10.2% [range: 0.01%–50.4%]), the retention rate was 86.3%. The %HFC substantially decreased after 6 months (−6.6% absolute units [−41% relatively]) and 18 months (−4.0% absolute units [−29% relatively]; p <0.001 vs. baseline). Reductions of HFC were associated with decreases in VAT beyond weight loss. After controlling for VAT loss, decreased %HFC remained independently associated with reductions in serum gamma glutamyltransferase and alanine aminotransferase, circulating chemerin, and glycated hemoglobin (p <0.05). While the reduction in HFC was similar between physical activity groups, MED/LC induced a greater %HFC decrease (p = 0.036) and greater improvements in cardiometabolic risk parameters (p <0.05) than the LF diet, even after controlling for VAT changes. Yet, the greater improvements in cardiometabolic risk parameters induced by MED/LC were all markedly attenuated when controlling for HFC changes. Conclusions: %HFC is substantially reduced by diet-induced moderate weight loss and is more effectively reduced by the MED/LC diet than the LF diet, independently of VAT changes. The beneficial effects of the MED/LC diet on specific cardiometabolic parameters appear to be mediated more by decreases in %HFC than VAT loss. Lay summary: High hepatic fat content is associated with metabolic syndrome, type 2 diabetes mellitus, and coronary heart disease. In the CENTRAL 18-month intervention trial, a Mediterranean/low-carbohydrate diet induced a greater decrease in hepatic fat content than a low-fat diet, conferring beneficial health effects that were beyond the favorable effects of visceral fat loss. ClinicalTrials.gov Identifier: NCT01530724.
KW - Cardiovascular risk
KW - Clinical trial
KW - Diet
KW - Hepatic fat content
KW - Lifestyle
KW - Low carbohydrate
KW - NAFLD
KW - Visceral adipose tissue
UR - http://www.scopus.com/inward/record.url?scp=85066274204&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.jhep.2019.04.013
DO - https://doi.org/10.1016/j.jhep.2019.04.013
M3 - مقالة
C2 - 31075323
SN - 0168-8278
VL - 71
SP - 379
EP - 388
JO - Journal of Hepatology
JF - Journal of Hepatology
IS - 2
ER -