Tratamento da doença hepática gordurosa não alcoólica exclusivamente com dieta, efeitos da intervenção nutricional sobre os valores das enzimas hepáticas, grau de esteatose e na resistência à insulina

• Ano de defesa: 2009
• Autor(a) principal: Elias, Maria Cristina [UNIFESP]
• Tipo de documento: Tese
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de São Paulo (UNIFESP)
• Palavras-chave em Português: Doença hepática gordurosa não alcoólica (DHGNA); Esteatoepatite não alcoólica (EHNA); Dieta; Obesidade; Resistência à insulina; Nonalcoholic fatty liver disease; Nonalcoholic steatohepatitis; Diet; Obesity; Insulin resistance
• Link de acesso: http://repositorio.unifesp.br/handle/11600/10135

Purpose: Evaluate the effect of diet therapy as exclusive treatment on insulin resistance, biochemical parameters of metabolic syndrome and degree of hepatic steatosis in patients with nonalcoolic fatty liver disease (NAFLD). Methods: Thirty-one patients diagnosed with NAFLD by computed tomography and/or liver biopsy received a restricted diet of energy (reduction of 500 to 100 kcal/day) containing 15% protein, 55% carbohydrates and 30% fat. The following parameters were evaluated at the entry and 6 months after dietary instructions: the degree of hepatic steatosis and visceral obesity by computed tomography, the serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyl transferase (GGT) levels, metabolic syndrome parameters, glycemia, triglycerides and high density liprotein (HDL-c) were measured by an automated method. Insulin concentration was determined by immunofluorometry and insulin resistance (IR) was calculated by homeostasis model assessment (HOMA-IR). Anthropometric variables, body mass index (BMI), waist circumference, waist-to-hip ratio, and food intake (7-day diary) were evaluated monthly. At the end of follow-up, the patients were classified as adherent or non-adherent to treatment according to a weight loss of more or less than 5% of initial body weight, respectively. Results were analyzed statistically using the Mann- Whitney, chi-square and Wilcoxon tests. Results: Seventeen of the 31 patients were classified as adherent (group 1) and 14 as non-adherent (group 2). Group 2 presented only a significant reduction in body mass index (BMI) and waist circumference. In contrast, in group 1, in addition to significant improvement of all anthropometric parameters, a significant reduction was observed in alanine aminotransferase (ALT) and gamma-glutamyl transferase (GGT) levels, homeostasis model assessment (HOMA-IR), visceral fat and tomographic liver density, together with an increase in high density liprotein (HDL-c) serum levels. These patients decrease presented a significant in total energy intake and in the amount of total and saturated fat. Conclusions: Nutritional intervention as exclusive treatment, with a loss of at least 5% of initial weight, was able to modify metabolic syndrome parameters, liver enzymes and degree of steatosis in patients with NAFLD, demonstrating that dietary intervention is effective in the treatment of this disease.