Effects of a multifactorial ecosustainable isocaloric diet on liver fat in patients with type 2 diabetes: randomized clinical trial

Giuseppe Della Pepa, Claudia Vetrani, Valentina Brancato, Marilena Vitale, Serena Monti, Giovanni Annuzzi, Gianluca Lombardi, Anna Izzo, Marianna Tommasone, Paola Cipriano, Gennaro Clemente, Peppino Mirabelli, Marcello Mancini, Marco Salvatore, Gabriele Riccardi, Angela Albarosa Rivellese, Lutgarda Bozzetto, Giuseppe Della Pepa, Claudia Vetrani, Valentina Brancato, Marilena Vitale, Serena Monti, Giovanni Annuzzi, Gianluca Lombardi, Anna Izzo, Marianna Tommasone, Paola Cipriano, Gennaro Clemente, Peppino Mirabelli, Marcello Mancini, Marco Salvatore, Gabriele Riccardi, Angela Albarosa Rivellese, Lutgarda Bozzetto

Abstract

Introduction: Treatment options for non-alcoholic fatty liver disease (NAFLD) in patients with type 2 diabetes (T2D) are still a matter of debate. We compared the effects of a diet including different components versus a proven beneficial diet rich in monounsaturated fatty acids (MUFAs) on liver fat in T2D.

Research design and methods: According to a parallel design, 49 individuals with T2D, overweight/obese, with high waist circumference, 35-75 years-old, in satisfactory blood glucose control with diet or drugs not affecting liver fat content, were randomly assigned to an 8-week isocaloric intervention with a MUFA diet (n=26) or a multifactorial diet rich in fiber, MUFA, n-6 and n-3 polyunsaturated fatty acids, polyphenols, and vitamins D, E, and C (n=23). Before and after the intervention, liver fat content was evaluated by proton magnetic resonance spectroscopy (1H-MRS). 1H-MRS complete data were available for n=21 (MUFA diet) and n=18 (multifactorial diet) participants.

Results: Adherence to dietary interventions was optimal. No significant differences between groups in body weight reduction, plasma glycated hemoglobin, insulin, glucose, lipids and liver enzymes were observed. Liver fat significantly decreased after both the multifactorial diet (9.18%±7.78% vs 5.22%±4.80%, p=0.003) and the MUFA diet (9.47%±8.89% vs 8.07%±8.52%, p=0.027) with a statistically significant difference between changes either in absolute terms (-4.0%±4.5% vs -1.4%±2.7%, p=0.035) or percent (-40%±33% vs -19%±25%, p=0.030).

Conclusions: An isocaloric multifactorial diet including several beneficial dietary components induced a clinically relevant reduction of liver fat in patients with T2D, more pronounced than that induced by simply replacing saturated fat with MUFA. This suggests that the 'optimal diet' for NAFLD treatment in T2D should be based on synergic actions of different dietary components on multiple pathophysiological pathways.

Trial registration number: NCT03380416.

Keywords: dietary intervention; liver fat; type 2 diabetes.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Absolute individual changes (A) and percent changes (B) in liver fat content measured by 1H-MRS after the 8-week intervention with MUFA diet or multifactorial diet. Dotted lines indicate individual values; solid lines denote mean values. Data are expressed as mean±SE. 1H-MRS, magnetic resonance spectroscopy; MUFA, monounsaturated fatty acid.
Figure 2
Figure 2
Spearman correlations between absolute changes after intervention in liver fat and γ-GT (A), fasting plasma glucose (B), and HbA1c (C) levels. ○, MUFA diet; ●, multifactorial diet; γ-GT, gamma-glutamyl transpeptidase; HbA1c, haemoglobin A1c; MUFA, monounsaturated fatty acid.

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