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Standardized ketogenic diet demonstrates ‘dramatic beneficial effects’ in patients with NASH

SAN DIEGO – A weight management program based on the ketogenic diet substantially improved metabolic parameters and markers of liver disease in patients with non-alcoholic steatohepatitis, according to results presented at Digestive Disease Week.

“This study was unique because there have only been two other studies, done 5 and 10 years ago, that used the ketogenic diet in nonalcoholic fatty liver disease,” Yuliya Belopolsky, MD, a resident in internal medicine at NorthShore University Health System, told Healio Gastroenterology. “This is the first study to look at NASH.”


The ketogenic diet, as well as diets that are calorically restricted, have demonstrated the ability to improve characteristics of metabolic syndrome, including NASH, according to Belopolsky and colleagues. The goal of the current study was to examine the impact of the “ideal protein diet,” a standardized, commercially available ketogenic diet, on metabolic parameters and markers of liver disease in patients with NASH.

The researchers performed a retrospective analysis of all patients with NASH from their institution who were referred to the weight management clinic between 2014 and 2018 (n = 43). They used medical records to obtain demographic and laboratory data, including age, sex, weight, BMI, serum glutamic oxaloacetic transaminase, serum glutamic pyruvic transaminase, blood pressure, HbA1c, LDL, HDL, triglycerides, platelets and albumin.

The presence of NASH was assessed with three methods, according to Belopolsky: liver biopsy, magnetic resonance elastography or FibroScan (Echosens). They evaluated noninvasive fibrosis with the FIB-4 index.

Patients were characterized based on their decision to enroll in the protein diet group (n = 38) or decline enrollment (n = 5). The group of patients who chose not to enroll in the program were considered the control arm.

After an average of 6.5 months, participants in the protein diet group exhibited substantial weight loss and improvement in insulin resistance, as demonstrated by HbA1c. In particular, 51% of patients in the protein diet group lost 10% or more of their body weight, which is a weight loss threshold that correlates with fibrosis improvement in NASH. FIB-4 scores and transaminases also declined substantially in this group. Researchers did not report any significant changes in the same data points for the control group.

The findings highlight the “dramatic beneficial effects of the ideal protein weight management regimen” on liver enzymes and a marker of liver fibrosis among a group of patients with NASH, according to Belopolsky and colleagues.

“The well-known beneficial effects on cardiovascular parameters and lipid profiles of the ideal protein protocol have been previously established,” the researchers wrote. “Furthermore, this protocol is structured to maintain the initial weight loss, a feature we consider critically important in our NASH population. Based on these promising results, we are planning to perform a long-term, prospective and randomized study of the ideal protein diet in [patients with NASH].”

The prospective study will follow patients for up to 2 years to determine if the diet can be maintained, according to Belopolsky. - by Julia Ernst, MS


Belopolsky Y, et al. Abstract Sa1627. Presented at: Digestive Disease Week; May 18-21, 2019; San Diego.

Disclosures: Belopolsky reports no relevant financial disclosures. Please see the abstract for a list of all other authors’ relevant financial disclosures.


Association between nut consumption and nonalcoholic fatty liver disease in adults

In this trial involving nearly 24,000 participants Tianjin Chronic Low-Grade Systemic Inflammation and Health (TCLSIH) Cohort Study, researchers assessed the link between nut consumption and nonalcoholic fatty liver disease (NAFLD) in the adult population via multivariable logistic regression. Utilizing a validated food frequency questionnaire, the investigators obtained information on dietary intake from all participants. NAFLD diagnosis was informed using abdominal ultrasonography. In all, the authors concluded that there was a significant connection between higher nut consumption and lower NAFLD prevalence. Even after further adjustment for blood lipids, glucose, and inflammation markers, these associations—although attenuated—remained significant.

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Liver Disease More Prevalent in Patients with Crohn's Disease

A study from investigators at the Cleveland Clinic has found that patients with Crohn’s disease (CD) may be at an increased risk of nonalcoholic fatty liver disease (NALFD), nonalcoholic steatohepatitis (NASH) and nonalcoholic cirrhosis (NC).

In a study of more than 62,000,000 patients, investigators found that prevalence rates of NAFLD, NASH, and NC among patients with CD were 3 times higher than in the general population. After noting it within their own practices, investigators sought to determine whether or not patients with CD were at an increased risk of chronic liver disease.

“It’s certainly an increasingly finding in my practice in caring for patients with inflammatory bowel disease (IBD), including Crohn’s disease, and there’s currently an epidemic of fatty liver disease in the western population,” explained Benjamin Click, MD, study author and associate staff gastroenterologist at the Cleveland Clinic in an interview with MD Magazine. “So, it’s important to understand if IBD patients are at any additional or different risk for liver disease.”

Investigators used electronic health record data, obtained through a commercial database, from 26 major US heal care systems to identify patients with a diagnosis of Crohn’s disease from 1999 to 2018.  Patients were identified with a Systemized Nomenclature of Medicine — Clinical Terms diagnosis of CD. Investigators used logistic regression of demographic and metabolic comorbidities to identify potential risk factors. Additionally, prevalence rates of first ever diagnosis of NAFLD, NASH, and NC after 30 days of CD diagnosis with the general population from the commercial database. 

A total of 62,781,880 individuals were included within the database and investigators identified 159,290 (0.25%) individuals with CD, 467,060 (0.74%) with NAFLD, 35,890 (0.06%) with NASH and 169,700 (0.27%) with NC. The prevalence rates of NAFLD, NASH, and NC were 3 times higher among patients with a CD diagnosis. In individuals with CD, the prevalence rate of NAFLD was 2.4%, NASH was 0.3%, and NC was 0.9%.

After comparing patients with CD patients with and without NAFLD, investigators found patients with NAFLD and CD were more likely to be females, Caucasian, and elderly. They were also significantly more likely to have comorbid diabetes mellitus (DM) , obesity, and hypertension (HTN). Similarly, CD patients with NASH were more likely to be females, Caucasian, and elderly. They were also significantly more likely to have comorbid DM, obesity, and HTN. CD patients with NC were more likely to be males, Caucasian, and elderly.

Investigators concluded that traditional metabolic risk factors for nonalcoholic fatty liver disease confer risk in CD and that the prevalence of NAFLD, NASH, and NC are significantly increased in patients with CD. Authors noted that additional studies were needed to assess the impact and interaction of IBD, medications, and the evolution of NAFLD. 

“This has big implications for investigating the potential mechanisms as to why that occurs and also in terms of management that we need to be watching for this, potentially screening for nonalcoholic fatty liver disease in our IBD patients, and then how this effects our current management strategies going forward is of great interest,” Click said. 

This study, titled “Nonalcoholic liver disease significantly more prevalent in Crohn’s disease: a population-based study,” was presented at DDW 2019 in San Diego, CA. 

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