低碳水化合物和低脂肪饮食对非酒精性脂肪性肝病疗效随机对照研究的Meta分析  

Effects of low-carbohydrate diet versus low-fat diet on non-alcoholic fatty liver disease: a meta-analysis of randomized controlled trials

作　　者：蔡伟祺 肖娟 林秋燕[1] 李丹[1] 刘榕华[1] Cai Weiqi;Xiao Juan;Lin Qiuyan;Li Dan;Liu Ronghua(Department of Digestive Diseases,Union Hospital of Fujian Medical University,Fuzhou 350001,China;Department of Nutrition,Union Hospital of Fujian Medical University,Fuzhou 350001,China)

机构地区：[1]福建医科大学附属协和医院消化内科,福州350001 [2]福建医科大学附属协和医院营养科,福州350001

出　　处：《中华临床营养杂志》2023年第1期39-47,共9页Chinese Journal of Clinical Nutrition

基　　金：福建省微创医疗中心建设项目(2021-76);国家临床重点专科(2021-76)。

摘　　要：目的:系统评价低碳水化合物饮食(low-carbohydrate diet,LCD)和低脂肪饮食(low-fat diet,LFD)在非酒精性脂肪性肝病(non-alcoholic fatty liver disease,NAFLD)生活方式治疗中的价值。方法:计算机检索PubMed、Embase、Web of Science、Cochrane、中国知网和万方数据库以及相关研究的参考文献和会议记录。由2名研究者独立筛选文献、提取数据、质量评价,采用R 4.4.1软件和RevMan 5.4.1进行Meta分析。使用随机效应模型分析异质和非异质结果。通过亚组分析识别异质性调节因子。采用漏斗图和peters检验分析潜在的发表偏倚。结果:搜索确定了1170篇文章,其中9项研究符合本研究的纳入标准,包括510例参与者。Meta分析结果显示,LCD相比于LFD在NAFLD患者治疗后肝脏脂肪含量(intrahepatic lipid content,IHLC)的减少中差异没有统计学意义(SMD:-0.31,95%CI:0.97~0.35,P=0.36),两种饮食模式治疗后的丙氨酸转氨酶(SMD:-0.35,95%CI:0.94~0.24,P=0.24)和天冬氨酸转氨酶(SMD:-0.45,95%CI:1.63~0.72,P=0.45)的降低差异无统计学意义。在亚组分析中,干预时间的不同可能是研究间异质性的原因。Meta分析未见明显发表偏倚。结论:检索自随机对照研究的证据不支持LCD对NAFLD的治疗效果优于LFD。Objective To compare the effects of low-carbohydrate diet(LCD)and low-fat diet(LFD)in the lifestyle intervention of non-alcoholic fatty liver disease(NAFLD)through a meta-analysis of randomized controlled trials.Methods PubMed,Embase,Web of Science,Cochrane,CNKI and Wanfang were searched for relevant studies and study references and conference proceedings were manually searched.Two authors independently screened the items retrieved,extracted the data and assessed the quality of included studies.Meta-analysis was performed using R4.4.1 and RevMan5.4.1.Data were pooled using random-effects models and potential sources of heterogeneity were investigated using stratified meta-analysis.Funnel plots and Peters'test were used to assess publication bias.Results Nine studies with a total of 510 participants met our inclusion criteria.Meta-analysis results showed that LCD and LFD interventions had similar effects on the reduction of intrahepatic lipid content in NAFLD patients(SMD:-0.31,95%CI:0.97 to 0.35,P=0.36).There were no significant differences in changes of alanine aminotransferase(SMD:-0.25,95%CI:0.91 to 0.41,P=0.45)and aspartate aminotransferase(SMD:-0.45,95%CI:1.63 to 0.72,P=0.45)levels,either.Subgroup analyses implied that the duration of different interventions might be the cause of heterogeneity across studies.No significant publication bias was showed in the meta-analysis.Conclusion Current evidence from randomized controlled studies does not support the superiority of LCD over LFD in the treatment of NAFLD.

关 键 词：非酒精性脂肪性肝病 低碳水化合物饮食 低脂肪饮食 META分析 

分 类 号：R575.5[医药卫生—消化系统]