Although a low-calorie diet with lipid restriction is recommended in clinical practice guidelines for nonalcoholic fatty liver disease, both compliance and adherence are poor. The present study aimed to evaluate the compliance, adherence, and effectiveness of a moderate-carbohydrate diet without caloric or lipid restrictions. In conclusion, compliance and adherence to our moderate-carbohydrate diet was high, and therapy appeared easy to maintain. Sustained correction of excessive carbohydrate intake would lead to not only reductions in body weight, visceral fat, and liver steatosis, but also improvements in pathophysiological states of nonalcoholic fatty liver disease such as chronic hepatitis, liver fibrosis, abnormal metabolisms, and low-grade systemic inflammation.

Abstract

Aim

Although a low-calorie diet with lipid restriction is recommended in clinical practice guidelines for nonalcoholic fatty liver disease (NAFLD), both compliance and adherence are poor. The present study aimed to evaluate the compliance, adherence, and effectiveness of a moderate-carbohydrate diet without caloric or lipid restrictions.

Methods

Participants comprised 300 patients with NAFLD with elevated ALT levels who received counseling in carbohydrate restriction (150–200 g/day). Complete response (CR) was defined as ALT normalization and partial response as a ≥30% reduction in ALT from baseline without CR.

Results

Dropout rates were 3% (10 of 300) after 6 months and 8% (23 of 300) after 12 months. Achievement rates of carbohydrate intake ≤200 g/day after 1, 3, 6, and 12 months were 80%, 81%, 80%, and 73%, respectively. CR and partial response rates were 60% and 31% after 6 months, and 65% and 25% after 12 months, respectively. Rates of achieving a ≥7% weight reduction after 6 and 12 months were 51% and 49%, respectively. Significant reductions in percentage body fat and visceral fat area were obtained, along with a significant increase in liver/spleen attenuation ratio. Serum lipids, uric acid, homeostatic model assessment for insulin resistance, hemoglobin A1c, C-reactive protein, ferritin, immunoglobulin, blood cell, shear wave velocity in the liver, and Mac-2-binding protein glycosylated isomers all decreased significantly.

Conclusions

Compliance and adherence to a moderate-carbohydrate diet without caloric or lipid restriction is high. The sustained high effectiveness of this therapy would improve the pathophysiological state of NAFLD.