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Article

Baseline HOMA IR and Circulating FGF21 Levels Predict NAFLD Improvement in Patients Undergoing a Low Carbohydrate Dietary Intervention for Weight Loss: A Prospective Observational Pilot Study

1
Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza University of Rome, 00161 Rome, Italy
2
Department of Endocrinology and Diabetes, University Campus Bio-Medico of Rome, 00128 Rome, Italy
3
Department of Surgical Sciences, Surgical Endoscopy Unit, Sapienza University of Rome, 00161 Rome, Italy
*
Author to whom correspondence should be addressed.
These authors contributed equally.
Nutrients 2020, 12(7), 2141; https://doi.org/10.3390/nu12072141
Received: 16 June 2020 / Revised: 7 July 2020 / Accepted: 15 July 2020 / Published: 18 July 2020
(This article belongs to the Special Issue Dietary Influence on Adipose Tissue Metabolism and Blood Lipid Levels)
Background: Non-alcoholic fatty liver disease (NAFLD) is a major cause of liver disease. Very low-calorie ketogenic diets (VLCKD) represent a feasible treatment as they induce profound weight loss and insulin resistance (IR) improvement. Despite the recognized benefits on NAFLD deriving from pharmacological administration of fibroblast growth factor 21 (FGF21), whose endogenous counterpart is a marker of liver injury, little is known about its physiology in humans. Aim: To identify predictors of NAFLD improvement as reflected by the reduction of the non-invasive screening tool hepatic steatosis index (HSI) in obese patients undergoing a weight loss program. Methods: Sixty-five obese patients underwent a 90-day dietary program consisting of a VLCKD followed by a hypocaloric low carbohydrate diet (LCD). Anthropometric parameters, body composition, and blood and urine chemistry were assessed. Results: Unlike most parameters improving mainly during the VLCKD, the deepest HSI change was observed after the LCD (p = 0.02 and p < 0.0001, respectively). Baseline HOMA-IR and serum FGF21 were found to be positive (R = 0.414, p = 0009) and negative (R = 0.364, p = 0.04) independent predictors of HSI reduction, respectively. Conclusions: We suggest that patients with IR and NAFLD derive greater benefit from a VLCKD, and we propose a possible role of human FGF21 in mediating NAFLD amelioration following nutritional manipulation. View Full-Text
Keywords: ketogenic diet; very low-calorie ketogenic diet; very low energy diet; very low carbohydrate diet; very low-calorie diet; non-alcoholic fatty liver disease; hepatic steatosis; fibroblast growth factor 21; weight loss; obesity; insulin resistance ketogenic diet; very low-calorie ketogenic diet; very low energy diet; very low carbohydrate diet; very low-calorie diet; non-alcoholic fatty liver disease; hepatic steatosis; fibroblast growth factor 21; weight loss; obesity; insulin resistance
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MDPI and ACS Style

Watanabe, M.; Risi, R.; Camajani, E.; Contini, S.; Persichetti, A.; Tuccinardi, D.; Ernesti, I.; Mariani, S.; Lubrano, C.; Genco, A.; Spera, G.; Gnessi, L.; Basciani, S. Baseline HOMA IR and Circulating FGF21 Levels Predict NAFLD Improvement in Patients Undergoing a Low Carbohydrate Dietary Intervention for Weight Loss: A Prospective Observational Pilot Study. Nutrients 2020, 12, 2141. https://doi.org/10.3390/nu12072141

AMA Style

Watanabe M, Risi R, Camajani E, Contini S, Persichetti A, Tuccinardi D, Ernesti I, Mariani S, Lubrano C, Genco A, Spera G, Gnessi L, Basciani S. Baseline HOMA IR and Circulating FGF21 Levels Predict NAFLD Improvement in Patients Undergoing a Low Carbohydrate Dietary Intervention for Weight Loss: A Prospective Observational Pilot Study. Nutrients. 2020; 12(7):2141. https://doi.org/10.3390/nu12072141

Chicago/Turabian Style

Watanabe, Mikiko, Renata Risi, Elisabetta Camajani, Savina Contini, Agnese Persichetti, Dario Tuccinardi, Ilaria Ernesti, Stefania Mariani, Carla Lubrano, Alfredo Genco, Giovanni Spera, Lucio Gnessi, and Sabrina Basciani. 2020. "Baseline HOMA IR and Circulating FGF21 Levels Predict NAFLD Improvement in Patients Undergoing a Low Carbohydrate Dietary Intervention for Weight Loss: A Prospective Observational Pilot Study" Nutrients 12, no. 7: 2141. https://doi.org/10.3390/nu12072141

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