Effect of green-Mediterranean diet on intrahepatic fat: the DIRECT PLUS randomised controlled trial

作者：Anat Yaskolka Meir, Ehud Rinott, Gal Tsaban, Hila Zelicha, Alon Kaplan, Philip Rosen, Ilan Shelef, Ilan Youngster, Aryeh Shaleṿ, Matthias Blüher, Uta Ceglarek, Michael Stümvoll, Kieran Michael Tuohy, Camilla Diotallevi, Urška Vrhovšek, Frank B. Hu, Meir J. Stampfer, Iris Shai · 发表于：Gut · 年份：2021 · DOI：10.1136/gutjnl-2020-323106 · 被引用次数：284 · 研究领域：Agriculture Sustainability and Environmental Impact、Nutritional Studies and Diet、Animal Nutrition and Physiology

Objective To examine the effectiveness of green-Mediterranean (MED) diet, further restricted in red/processed meat, and enriched with green plants and polyphenols on non-alcoholic fatty liver disease (NAFLD), reflected by intrahepatic fat (IHF) loss. Design For the DIRECT-PLUS 18-month randomized clinical trial, we assigned 294 participants with abdominal obesity/dyslipidaemia into healthy dietary guidelines (HDG), MED and green-MED weight-loss diet groups, all accompanied by physical activity. Both isocaloric MED groups consumed 28 g/day walnuts (+440 mg/day polyphenols provided). The green-MED group further consumed green tea (3–4 cups/day) and Mankai (a Wolffia globosa aquatic plant strain; 100 g/day frozen cubes) green shake (+1240 mg/day total polyphenols provided). IHF% 18-month changes were quantified continuously by proton magnetic resonance spectroscopy (MRS). Results Participants (age=51 years; 88% men; body mass index=31.3 kg/m 2 ; median IHF%=6.6%; mean=10.2%; 62% with NAFLD) had 89.8% 18-month retention-rate, and 78% had eligible follow-up MRS. Overall, NAFLD prevalence declined to: 54.8% (HDG), 47.9% (MED) and 31.5% (green-MED), p=0.012 between groups. Despite similar moderate weight-loss in both MED groups, green-MED group achieved almost double IHF% loss (−38.9% proportionally), as compared with MED (−19.6% proportionally; p=0.035 weight loss adjusted) and HDG (−12.2% proportionally; p<0.001). After 18 months, both MED groups had significantly higher total pla...