关键词: 肝疾病, 非酒精性脂肪肝病, 饮食治疗, 膳食补充剂, 抗氧化, 人体成分, 治疗结果

Abstract: Background　Non-alcoholic fatty liver disease（NAFLD）has become the first major chronic liver disease in China，bringing about severe disease burden.Due to lack of effective drug therapies，dietary therapy is an essential and important treatment for NAFLD.However，there is still a lack of guidance and standards for carrying out nutritional therapy and evaluating the efficacy.Objective　To investigate the effects of individualized precision dietary therapy with antioxidant dietary supplements（grape seed extract）on body composition，liver hardness，serum indicators of liver function and inflammation in NAFLD patients.Methods　One hundred NAFLD patients aged 18-65 years were recruited from Nutrition Department，and Fatty Liver Disease Subspecialty Clinic，GI Medicine Department，Guangdong Provincial People's Hospital using convenient sampling from April 2018 to July 2019.Those with an even appointment number and with an odd appointment number were equally and randomly assigned to control and treatment arms（each n=50），respectively.All patients were given individualized nutrition therapy by nutrition specialists based on the principle of " eating balanced meals on a modified diet with limited carbohydrate，energy and low glycemic load".The cases in the treatment arm additionally received antioxidant dietary supplements，2 tablets once daily.Information was obtained，including age，sex，anthropometric indicators〔height，body weight，BMI，neck circumference（NC），waist circumference（WC）and hip circumference（HC）〕，body composition〔fat mass（FM），muscle mass，basal metabolic rate（BMR）and visceral fat rating（VFR）〕，liver hardness〔stiffness and controlled attenuation parameter（CAP）〕，serum indicators〔alanine aminotransferase（ALT），aspartate transaminase（AST），gamma-glutamyl transpeptidase（GGT），triglyceride（TG），total cholesterol，high-density lipoprotein（HDL），free fatty acid（FFA），total 25-hydroxy vitamin D，superoxide dismutase（SOD），high-sensitivity C-reactive protein（hs-CRP）〕 and lipid accumulation product（LAP） index.Pre-post treatment changes in each arm and inter-arm differences were analyzed.Results　Nine dropouts（4 controls and 5 cases）were excluded，the remaining 91 patients were finally enrolled.BMI，NC，WC，and HC were significantly decreased after treatment in patients of both arms（P<0.05）.Body weight，FM，BMR，VFR，LAP index，CAP，ALT，GGT，and hs-CRP were decreased after treatment in the control arm（P<0.05）.In the treatment arm，body weight，FM，VFR，LAP index，liver hardness，CAP，ALT，GGT，TG，FFA，and hs-CRP were decreased，and HDL and SOD were increased after treatment（P<0.05）.The treatment arm showed lower FFA concentration and higher SOD level after treatment compared to the control arm（P<0.05）.Conclusion　 In NAFLD patients，individualized precision dietary therapy developed and delivered by nutrition specialists and regular follow-ups could improve parameters of anthropometry，body composition，liver hardness，serum biochemical indicators of liver function and inflammation.Antioxidant dietary supplements were synergistic with dietary therapy in improving lipid metabolism，reducing the concentration of FFA and increasing the SOD level.

Key words: Liver diseases, Non-alcoholic fatty liver disease, Diet therapy, Dietary supplements, Antioxidant, Body composition, Treatment outcome