[PDF][PDF] A low‐carbohydrate diet rapidly and dramatically reduces intrahepatic triglyceride content

JD Browning, J Davis, MH Saboorian… - Hepatology, 2006 - Wiley Online Library
JD Browning, J Davis, MH Saboorian, SC Burgess
Hepatology, 2006Wiley Online Library
During November of 2005, a 42-year-old white woman taking conjugated estrogen since
age 16 was seen for evaluation of right upper quadrant pain of 6 months' duration. She was
obese with mixed hyperlipidemia but had no evidence of diabetes mellitus or impaired
fasting glucose. Initial workup indicated hepatomegaly (craniocaudal dimension: 26 cm) with
an increased serum alanine aminotransferase concentration (55 U/L). Viral and autoimmune
serologies were negative, and no heritable or environmental (ie, ethanol) cause of liver …
During November of 2005, a 42-year-old white woman taking conjugated estrogen since age 16 was seen for evaluation of right upper quadrant pain of 6 months’ duration. She was obese with mixed hyperlipidemia but had no evidence of diabetes mellitus or impaired fasting glucose. Initial workup indicated hepatomegaly (craniocaudal dimension: 26 cm) with an increased serum alanine aminotransferase concentration (55 U/L). Viral and autoimmune serologies were negative, and no heritable or environmental (ie, ethanol) cause of liver disease was identified. Ultrasound examination of the liver was consistent with diffuse fatty infiltration of the liver. A diagnosis of non-alcoholic fatty liver disease (NAFLD) was confirmed by liver proton magnetic resonance spectroscopy, which demonstrated a liver triglyceride content of 44.6%(normal: 5.5%) 1 (Fig. 1). Discontinuation of conjugated estrogen was unsuccessful at relieving symptoms, and because of the patient’s body mass index (32.2 kg/m2), dietary therapy was initiated to promote weight loss. The diet chosen was the Atkins diet, emphasizing the selection of healthy sources of protein and fat. 2
At day 7 of the diet, she was ketotic with a urinary ketone concentration of 150 mg/dL. Liver biopsy was performed at this visit and showed pan-lobular macrovesicular steatosis without evidence of inflammatory activity or fibrosis. At day 14 of the diet, she remained ketotic with a respiratory quotient of 0.72 by indirect calorimetry. Body mass index had fallen to 30.9 kg/m2 (6.4 kg) with a modest decrement in abdominal pain. Dietary composition over this 2-week period was 54% protein, 41% fat, and 5% carbohydrate with an estimated daily caloric intake of approximately 1,000 kcal. Saturated,
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