临床肝胆病杂志2025，Vol.41Issue(12)：2528-2535,8.DOI:10.12449/JCH251214
基于China-PAR模型评估极低碳水化合物饮食对代谢相关脂肪性肝病患者心血管风险的影响
Impact of very-low-carbohydrate diet on cardiovascular risk in patients with metabolic associated fatty liver disease based on the China-PAR model
摘要
Abstract
Objective To investigate the effectiveness and safety of very-low-carbohydrate diet(VLCD)in the treatment of metabolic associated fatty liver disease(MAFLD)by observing its impact on various indicators,and to provide a basis for clinical treatment.Methods This single-center retrospective single-arm cohort study was conducted among 103 patients who were diagnosed with MAFLD in Dongzhimen Hospital,Beijing University of Chinese Medicine,from September 2021 to May 2024,and all patients received the VLCD intervention regimen for 2—6 weeks.Related indicators were compared before and after treatment,including body weight,body mass index(BMI),liver controlled attenuation parameter(CAP),fasting plasma glucose(FPG),fasting serum C-peptide(C-P),fasting serum insulin(FINS),Homeostasis Model Assessment of Insulin Resistance(HOMA-IR),total cholesterol(TC),triglycerides(TG),high-density lipoprotein cholesterol(HDL-C),and low-density lipoprotein cholesterol(LDL-C).Finally,the China-PAR cardiovascular risk prediction model was used to calculate the risk of cardiovascular events before and after treatment and evaluate the impact of this dietary intervention on cardiovascular health.The paired t-test or the Wilcoxon signed-rank test was used for comparison of continuous data between groups.Results After VLCD treatment,there were significant reductions in body weight,BMI,and CAP(Z=-8.515,-8.495,and-8.204,all P<0.001),and there were significant improvements in FPG,FINS,C-P,and HOMA-IR(Z=-4.215,-5.310,-4.482,and-5.422,all P<0.001).There was a significant reduction in TG after treatment(Z=-5.373,P<0.001).The China-PAR model showed significant reductions in the 10-year and lifetime risk assessment indices of cardiovascular disease in 103 patients(Z=-5.406 and-5.383,both P<0.001).The subgroup analysis based on sex showed that in the male group,there were significant differences in body weight,BMI,CAP,FPG,FINS,C-P,HOMA-IR,TG,blood pressure,waist circumference,and the risk of cardiovascular disease before and after treatment(all P<0.05),while in the female group,there were significant reductions in body weight,BMI,CAP,FPG,FINS,C-P,HOMA-IR,TC,TG,LDL-C,blood pressure,waist circumference,and the risk assessment of cardiovascular disease(all P<0.05).The subgroup analysis based on age showed that in the youth group,there were significant reductions in body weight,BMI,CAP,FPG,FINS,C-P,HOMA-IR,TG,systolic blood pressure,waist circumference,and the risk assessment of cardiovascular disease(all P<0.05);in the middle-aged group,there were significant reductions in body weight,BMI,CAP,FPG,FINS,C-P,HOMA-IR,TG,systolic blood pressure,diastolic blood pressure,waist circumference,and the risk assessment of cardiovascular disease(all P<0.05);in the elderly group,there were significant reductions in body weight,BMI,CAP,systolic blood pressure,waist circumference,and the risk assessment of cardiovascular disease(all P<0.05).After treatment,there were 43 patients with an increase in TC(41.7%),24 patients with an increase in TG(23.3%),and 43 patients with an increase in LDL-C(41.7%);53 patients(51.5%)showed a reduction in HDL-C;9 patients(8.7%)showed an increase in CAP;26 patients(25.2%)had an increase in HOMA-IR.Conclusion VLCD can effectively alleviate fatty liver disease and reduce insulin resistance in the treatment of MAFLD,without increasing the risk of cardiovascular disease.关键词
代谢相关脂肪性肝病/膳食,低碳水化合物/心血管疾病Key words
Metabolic Associated Fatty Liver Disease/Diet,Carbohydrate-Restricted/Cardiovascular Diseases引用本文复制引用
张珺洁,皮珊珊,邓金燕,吴子彧,李悦,王倩,杜宏波..基于China-PAR模型评估极低碳水化合物饮食对代谢相关脂肪性肝病患者心血管风险的影响[J].临床肝胆病杂志,2025,41(12):2528-2535,8.基金项目
首都卫生发展科研专项(首发2024-2-4195) （首发2024-2-4195）
第五批全国中医临床优秀人才研修项目(国中医药人教函[2022]1号) Capital's Funds for Health Improvement and Research(2024-2-4195) （国中医药人教函[2022]1号）
The National Administration of Traditional Chinese Medicine Letter([2022]-1) （[2022]-1）
