Elsevier

Clinical Nutrition

Volume 25, Issue 5, October 2006, Pages 816-823
Clinical Nutrition

ORIGINAL ARTICLE
How different is the dietary pattern in non-alcoholic steatohepatitis patients?

https://doi.org/10.1016/j.clnu.2006.01.027Get rights and content

Summary

Background/aims

This study aimed at evaluating whether patients with non-alcoholic steatohepatitis (NASH) had a specific dietary pattern and how it compared with data representative from the same geographical region individuals.

Subjects and methods

Clinical, biochemical and anthropometrics: weight, height, body mass index (BMI) and waist circumference were collected in 45 NASH patients. Diet history was assessed using a validated semi-quantitative food frequency questionnaire, analysed with the Food Processor Plus®, and was compared, after adjustment for BMI, with data from a sample of 856 free-living individuals, frequency matched for sex and age.

Results

Patients’ mean age was 49.6±10.6 years, 26 F: 19 M, BMI: 31.2±5.0 kg/m2. Comparison of their diet history with control data (C) revealed that carbohydrate consumption was lower in patients (P): P—243.6±5.7 g vs. C—261.5±1.6 g, P<0.05, and most patients had very low fibre intake. Conversely, total fat consumption was higher in patients: P—79.7±1.7 g vs. 73.0±0.4, P<0.01. A significantly higher intake of n-6 fatty acids (P=0.003) and n-6/n-3 ratio was found in patients, P<0.001.

Conclusions

Our results suggest that the quality and combination of carbohydrates and fat intake may be more relevant than their isolated amount; an increased fat intake with an excessive amount of n-6 fatty acids can be implicated in promoting necro-inflammation, and provides further grounds for individualized dietary therapy.

Introduction

Non-alcoholic steatohepatitis (NASH) is characterized by liver fat infiltration with various degrees of inflammation, necrosis and fibrosis, similar to alcoholic hepatitis in the absence of significant alcohol intake.1 In recent years, it became increasingly evident that fatty liver with necroinflammation (NASH) is part of a broader spectrum, non-alcoholic fatty liver disease (NAFLD), ranging from fatty liver to “cryptogenic” cirrhosis.2, 3, 4, 5

The primary forms of the disease, once drugs, toxins, or other causes are excluded, have often been associated with obesity, insulin resistance, and the metabolic syndrome.6, 7, 8 Despite the apparent links to metabolic disorders, the mechanisms of the disease are as yet poorly understood, and little is known about patient's diet history and its potential role in oxidative stress, thought to be involved in the progression to steatohepatitis.9, 10, 11, 12, 13, 14 Dietary factors, namely the type of fat, may indeed favour oxidative stress phenomena, and patient management usually includes diet modifications, despite the lack of supporting evidence.

Two recent studies on dietary intake of selected NAFLD patients disclosed dissimilar results; one reported saturated fat/cholesterol-rich diets yet poor in polyunsaturated fat, fibre, and vitamins C and E,15 whilst the other highlighted the association between higher carbohydrate intake with significantly higher odds of inflammation.16 So far, the pattern of dietary and nutrient intake in NASH remains scarcely evaluated and controversial.

Therefore, the aim of the present study conducted in non-selected patients with biopsy-proven NASH was to analyse their past diet and how it compared with data reported by common free-living subjects, frequency matched for sex and age, from the same geographical region; data analysis was adjusted for individual body mass index (BMI), in order to avoid potential bias associated with weight. Adequacy of patient's nutrient intake was further evaluated in function of recommended Dietary Reference Intakes (DRIs).

Section snippets

Patients

Between March and August 2004, 56 biopsy-proven NASH patients referred to our outpatient Liver Unit were invited to participate and 45 did accept. The diagnosis of NASH was based on the accepted clinico-histological criteria,17 which requires the exclusion of other causes of liver disease, namely alcohol intake >20 g/day, markers of chronic viral infection B and C, α1 antitrypsin deficiency, primary biliary cirrhosis, hemochromatosis, auto-immune hepatitis, and Wilson's disease.

The study was

NASH patients and controls characteristics

General demographic, anthropometric, clinical and key laboratory data from patients and controls are presented in Table 1. Women were prevalent in both groups and mean age was overall 50 years. None of the participants was undernourished; among patients, two (4%) had normal weight, 15 (32%) were overweight, and 28 (64%) were obese. Hypertension, diabetes and dyslipidemia were very common; the prevalence of hypertension was similar in both groups, though the prevalence of diabetes was

Discussion

In this study, we have shown that NASH patients recall a diet richer in fat and poorer in carbohydrates and protein when compared to a large sample of the general population. Unlike Musso et al.15 who reported increased saturated fat consumption, our patients had a higher consumption of monounsaturated fat than controls, however low to recommendations in 82%; study groups were nevertheless very different. Furthermore, in order to study patients as seen in everyday practice, our sample included

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