The Replacement of Only One Portion of Starchy Carbohydrates with Green Leafy Vegetables Regresses Mid and Advanced Stages of NAFLD: Results from a Prospective Pilot Study

Abstract

The gold standard treatment for NAFLD is weight loss and lifestyle interventions, which require a diet enriched in fiber and reduced in sugars and saturated fats. Fibres may be advantageous for NAFLD patients since they reduce and slow the absorption of carbohydrates, lipids, and proteins, lowering the energy density of the meal and increasing their sense of satiety. Furthermore, the polyphenol content and other bioactive compounds of vegetables have antioxidant and anti-inflammatory properties preventing disease progression. The aim of this study is to ascertain the effects of a diet enriched by green leafy vegetables and with a moderate restriction of carbohydrate intake in patients with NAFLD over a three month period. Among the forty patients screened, twenty four patients completed the clinical trial consisting of swapping one portion of carbohydrate-rich food for one portion of green leafy vegetables, and liver and metabolic markers of NAFLD were evaluated. All patients underwent routine blood tests, anthropometric measurements, bioelectrical impedance analysis, fibroscan, and fatty liver index (FLI) evaluation before and at the end of the study. The population under study (n = 24) had a median age of 47.5 (41.5–52.5) years and included mainly women (70.8%). We found that FLI, which is used to predict fatty liver (73 (33–89) vs. 85 (54–95), p < 0.0001) and the FAST score, which is a fibroscan-derived parameter identifying patients at risk of progressive NASH (0.03 (0.02–0.09) vs. 0.05 (0.02–0.15), p = 0.007), were both improved after changes in diet. The BMI (33.3 (28.6–37.3) vs. 35.3 (31.2–39.0), p < 0.0001), WC (106.5 (95.0–112.5) vs. 110.0 (103.0–124.0), p < 0.0001), neck circumference (38.0 (35.0–41.5) vs. 39.5 (38.0–42.5), p < 0.0001), fat mass (32.3 (23.4–40.7) vs. 37.9 (27.7–43.5), p < 0.0001), and extracellular water (17.3 (15.2–20.8) vs. 18.3 (15.9–22.7), p = 0.03) were also all significantly lower after three months of diet. Metabolic parameters linked to NAFLD decreased: HbA1c (36.0 (33.5–39.0) vs. 38.0 (34.0–40.5), p = 0.01), triglycerides (72 (62–90) vs. 90 (64–132), p = 0.03), and the liver markers AST (17 (14–19) vs. 18 (15–27), p = 0.01) and γGT (16 (13–20) vs. 16 (14–27), p = 0.02). In conclusion, replacing only one portion of starchy carbohydrates with one portion of vegetables for a three month period is sufficient to regress, at least in part, both mid and advanced stages of NAFLD. This moderate adjustment of lifestyle habits is easily achievable.