Plain language summary
The diagnosis and treatment of non-alcoholic fatty liver disease (NAFLD) is critical, however, there isn’t an effective treatment readily available. On the other hand, lifestyle modifications, particularly a calorie-restricted diet, habitual physical activity, and weight loss, have been advocated for the treatment of NAFLD. The hypothesis of this study was that a freshwater fish-based diet would induce a greater improvement in hepatic steatosis by regulating gut microbiota and its metabolites compared with an alternating combination of freshwater fish-based and red meat-based diets. This study was a randomised, open-label and controlled clinical trial which enrolled participants who were clinically diagnosed of NAFLD with a presence of hepatic steatosis. Participants (n=34) were randomly assigned to either a freshwater fish-based diet or the combination of a freshwater fish-based diet and a red meat-based diet at a daily alternating frequency in a 1:1 ratio. Results showed that dietary freshwater fish consumption: - alleviates liver steatosis in participants with NAFLD; - ameliorates several metabolic phenotypes in participants with NAFLD; - partially redresses gut microbiota dysbiosis in the improvement of the metabolic phenotypes of participants with NAFLD; - improves NAFLD by inducing metabolites alternation. Authors conclude that even though the freshwater fish-based diet showed various positive results for participants with NAFLD, the alternating freshwater fish and red meat consumption may not exacerbate NAFLD, which may be more appropriate to fit the daily eating habits and food diversity for long-term implementation.
Abstract
INTRODUCTION We aimed to assess the effects of 2 isoenergetic intervention diets (a freshwater fish-based diet [F group] or freshwater fish-based and red meat-based diets alternately [F/M group]) on liver steatosis and their relationship with intestinal flora in patients with nonalcoholic fatty liver disease (NAFLD). METHODS In this open-label, 84-day randomized controlled trial, 34 NAFLD patients with hepatic steatosis ≥10% were randomly assigned to the F group or F/M group in a 1:1 ratio using a computer-generated random number allocation by a researcher not involved in the study. Liver fat content and gut microbiota and its metabolites were measured. RESULTS At the end of intervention, the absolute reduction of hepatic steatosis was significantly greater in the F group than in the F/M group (-4.89% vs -1.83%, P = 0.032). Of the 16 secondary clinical outcomes, the improvement in 7 in the F group was greater compared with the F/M group, including alanine aminotransferase and gamma-glutamyl transferase. Furthermore, dietary freshwater fish and red meat consumption alternately did not exacerbate NAFLD. Moreover, changes in the enrichment of Faecalibacterium, short-chain fatty acids, and unconjugated bile acids and the depletion of Prevotella 9 and conjugated bile acids in the F group were significantly greater compared with the F/M group. DISCUSSION Higher intake of freshwater fish may be beneficial to NAFLD by regulating gut microbiota and its metabolites, whereas intake of a similar total of animal protein and fat from the alternating freshwater fish and red meat may not be harmful for NAFLD in the dietary management of patients with NAFLD.
Methodological quality
Jadad score
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3
Allocation concealment
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Yes
