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Randomized Controlled Trial
. 2022 May 26;14(11):2223.
doi: 10.3390/nu14112223.

Effect of Dietary and Lifestyle Interventions on the Amelioration of NAFLD in Patients with Metabolic Syndrome: The FLIPAN Study

Sofía Montemayor  1   2 , Cristina Bouzas  1   2   3 , Catalina M Mascaró  1   2 , Miguel Casares  4 , Isabel Llompart  1   2   5 , Itziar Abete  3   6 , Escarlata Angullo-Martinez  1   2   7 , María Ángeles Zulet  3   6 , J Alfredo Martínez  6   8 , Josep A Tur  1   2   3
Affiliations
Randomized Controlled Trial

Effect of Dietary and Lifestyle Interventions on the Amelioration of NAFLD in Patients with Metabolic Syndrome: The FLIPAN Study

Sofía Montemayor et al. Nutrients. .

Abstract

Background: Adults with fatty liver present unusual glycaemia and lipid metabolism; as a result, non-alcoholic fatty liver disease (NAFLD) is now considered as part of the metabolic syndrome (MetS).

Objective: To assess the 6- and 12-month effects of customized hypocaloric dietary and enhanced physical activity intervention on intrahepatic fat contents and progression of NAFLD, in patients with MetS.

Design: Cross-sectional study in 155 participants (40-60 years old) from Balearic Islands and Navarra (Spain) with a diagnosis of NAFLD and MetS, and BMI (body mass index) between 27 and 40 kg/m2; patients were randomized in a 1:1:1 ratio to either Conventional Diet, Mediterranean diet (MD)-high meal frequency, and MD-physical activity groups.

Methods: Dietary intake was assessed using a validated food frequency questionnaire. Adherence to Mediterranean diet, anthropometrics, physical activity, and biochemical parameters (fasting glucose, glycated hemoglobin, bilirubin, aspartate aminotransferase, alanine aminotransferase-ALT-, gamma-glutamyl transferase, uric acid, urea, creatinine, albumin, total cholesterol, high-density lipoprotein cholesterol-HDL-cholesterol-, and triglycerides) were also assessed.

Results: Subjects with NAFLD and MetS had reduced intrahepatic fat contents, and liver stiffness, despite the intervention the participants went through. All participants ameliorated BMI, insulin, Hb1Ac, diastolic blood pressure, HDL-cholesterol, and ALT, and improved consumption of total energy, fish, and legumes. Participants in the MD-HMF group improved waist circumference.

Conclusions: Customized hypocaloric dietary and enhanced physical activity interventions may be useful to ameliorate NAFLD.

Keywords: FLIPAN; Mediterranean diet; NAFLD; intrahepatic fat contents; metabolic syndrome; physical activity.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of the study.
Figure 2
Figure 2
Changes in anthropometric, metabolic, and liver parameters at 6 and 12 months follow-up versus baseline. CD: Conventional Diet; MD–HMF: Mediterranean diet–high meal frequency; MD–PA: Mediterranean diet–physical activity (control group). Physical activity was represented as MET × 10−2. Triglycerides were represented as mg/dL.
Figure 3
Figure 3
Changes in adherence to MedDiet, energy and nutrients intake at 6 and 12 months follow-up versus baseline. CD: Conventional Diet; MD–HMF: Mediterranean diet–high meal frequency; MD–PA: Mediterranean Diet–physical activity (control group). Energy was represented as kcal × 10−2. Meat and dairy intake were represented as g/d per 100 kcal.
See this image and copyright information in PMC

References

    1. Wong R.J., Aguilar M., Cheung R., Perumpail R.B., Harrison S.A., Younossi Z.M. Non-alcoholic steatohepatitis is the second leading etiology of liver disease among adults awaiting liver transplantation in the United States. Gastroenterology. 2015;148:547–555. doi: 10.1053/j.gastro.2014.11.039. - DOI - PubMed
    1. Younossi Z.M., Marchesini G., Pinto-Cortez H., Petta S. Epidemiology of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis: Implications for liver transplantation. Transplantation. 2019;103:22–27. doi: 10.1097/TP.0000000000002484. - DOI - PubMed
    1. Buzzetti E., Pinzani M., Tsochatzis E.A. The multiple-hit pathogenesis of non-alcoholic fatty liver disease (NAFLD) Metabolism. 2016;65:1038–1048. doi: 10.1016/j.metabol.2015.12.012. - DOI - PubMed
    1. Gadiparthi C., Spatz M., Greenberg S., Iqbal U., Kanna S., Satapathy S.K., Broder A., Ahmed A. NAFLD epidemiology, emerging pharmacotherapy, liver transplantation implications and the trends in the United States. J. Clin. Trans. Hepatol. 2020;8:215–221. doi: 10.14218/JCTH.2020.00014. - DOI - PMC - PubMed
    1. European Association for the Study of the Liver (EASL) European Association for the Study of Diabetes (EASD) European Association for the Study of Obesity (EASO) EASL-EASD-EASO clinical practice guidelines for the management of non-alcoholic fatty liver disease. J. Hepatol. 2016;64:1388–1402. doi: 10.1016/j.jhep.2015.11.004. - DOI - PubMed

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