Metabolic syndrome is associated with greater histologic severity, higher carbohydrate, and lower fat diet in patients with NAFLD.

OBJECTIVES: Nonalcoholic fatty liver disease (NAFLD) is considered as the hepatic manifestation of metabolic syndrome. Insulin resistance (IR) is a key component of metabolic syndrome. The aim was to determine the dietary composition, physical activity, and histologic severity between NAFLD patients with and without metabolic syndrome. METHODS: Ninety-one patients with NAFLD completed the Block Food Frequency Questionnaire and the Paffenbarger Physical Activity Questionnaire. IR was assessed by the homeostasis model assessment (HOMA) index. Metabolic syndrome was defined by the ATP III clinical definition. Nonalcoholic steatohepatitis (NASH) Clinical Network Scoring System was used to determine the histologic severity of NAFLD. RESULTS: Thirty-one patients (34%) had metabolic syndrome. Patients with metabolic syndrome had a higher HOMA index (7.66 vs 4.45, p = 0.04), and consumed more carbohydrates (51%vs 45%, p = 0.03) and less fat (34%vs 40%, p = 0.01) compared with those without metabolic syndrome; total daily calorie, protein consumption, and physical activity were similar between the two groups. Patients with metabolic syndrome had higher scores for steatosis (2.0 +/- 0.8 vs 1.37 +/- 1, p = 0.02), NASH activity (4.13 +/- 1.4 vs 3.13 +/- 1.7, p = 0.004), and global NASH score (5.9 +/- 1.7 vs 4.4 +/- 2.3, p = 0.0006) compared with those without metabolic syndrome. When controlled for other factors including dietary composition and physical activity, the presence of metabolic syndrome was a significant risk factor for global NASH severity in addition to HOMA index and female gender. CONCLUSION: Metabolic syndrome in patients with NAFLD is associated with a diet containing more carbohydrate and less fat and greater histologic severity. The role of a carbohydrate-restricted diet in decreasing the risk for metabolic syndrome and histologic severity should be assessed in patients with NAFLD.

One-year intense nutritional counseling results in histological improvement in patients with non-alcoholic steatohepatitis: a pilot study.

BACKGROUND AND AIM: In individuals with biopsy-proven non-alcoholic steatohepatitis (NASH), short-term weight loss has been shown to improve biochemical abnormalities; however, its effect on liver histology is largely unknown. The aim of the article is to determine if dietary intervention is effective in improving histological features of steatohepatitis in patients with biopsy-proven NASH. METHODS: Twenty-three patients (11M/12F) with BMI >25 kg/m(2) and biopsy-proven NASH received standardized nutritional counseling aimed at reducing insulin resistance (IR) and weight. Blood tests were checked at baseline and every 1-4 months, and liver biopsy was repeated at month 12. IR was assessed by the homeostasis model assessment (HOMA). Liver biopsies were scored according to modified Brunt criteria for NASH. "Histologic response" was defined as a reduction in total NASH score of >/=2 points with at least one point being in the non-steatosis component. RESULTS: Sixteen patients (8M/8F) completed 12 months of dietary intervention, and 15 underwent repeat liver biopsies. At month 12, mean weight decreased from 98.3 to 95.4 kg. Mean waist circumference, visceral fat, fasting glucose, IR, triglycerides, AST, ALT, and histologic score were all reduced but the difference was not significant. Nine patients had a histologic response, six had stable scores, and none had a worsened score. Compared to patients with unchanged histologic scores, patients with improved scores had significantly greater reduction in weight, waist circumference, AST, ALT, steatosis grade, and total NASH score. CONCLUSION: Among patients who successfully completed 1 yr of intense dietary intervention, nine of 15 patients with NASH displayed histologic improvement. This pilot study suggests that dietary intervention can be effective in improving histology in patients with biopsy-proven NASH.