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Serum Alanine Aminotransferase Levels Decrease Further with Carbohydrate than Fat Restriction in Insulin Resistant Adults

¹Division of Cardiovascular Medicine, Falk Cardiovascular Research Center, Stanford University School of Medicine 300 Pasteur Drive, Stanford 94305
²Division of Endocrinology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford 94305

mryan{at}cvmed.stanford.edu

ABSTRACT

Objectives:: While weight loss interventions have been shown to reduce steatosis in nonalcoholic fatty liver disease (NAFLD), the impact of dietary macronutrient composition is unknown. We assessed the effect on serum ALT concentrations of two hypocaloric diets, varying in amounts of carbohydrate (CHO) and fat; in obese, insulin-resistant individuals: a population at high risk for NAFLD.

Research Design and Methods:: Post-hoc analysis was performed of ALT concentrations in 52 obese subjects with normal baseline values, and insulin resistance as quantified by the steady-state plasma glucose test (SSPG), who were randomized to hypocaloric diets containing either 60%CHO-25%fat or 40%CHO-45%fat (15% protein), for 16 weeks. Primary endpoint was change in ALT, which was evaluated according to diet, weight loss, SSPG, and daylong insulin concentrations.

Results:: Although both diets resulted in significant decreases in weight, SSPG, daylong insulin, and serum ALT concentrations, the 40% CHO diet resulted in greater decreases in SSPG (p<0.04), circulating insulin (p<0.01), and ALT (9.5± 9.4 vs. 4.2± 8.3 U/L,p<0.04) concentrations. ALT changes correlated with improvement in insulin sensitivity (p=0.04) and daylong insulin (p<0.01). Individuals with ALT concentrations above proposed upper limits experienced significant declines in ALT, unlike those with lower ALT levels.

Conclusions:: In a population at high risk for NAFLD, a hypocaloric diet moderately lower in CHO decreased serum ALT concentrations to a greater degree than a higher CHO-low fat diet, despite equal weight loss. This may result from a relatively greater decline in daylong insulin concentrations. Further research with histological endpoints is needed to further explore this finding.

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				C. Gasteyger, T. M. Larsen, F. Vercruysse, and A. Astrup Effect of a dietary-induced weight loss on liver enzymes in obese subjects Am. J. Clinical Nutrition, May 1, 2008; 87(5): 1141 - 1147. [Abstract] [Full Text] [PDF]