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

摘要： 背景　非酒精性脂肪性肝病（NAFLD）已成为我国第一大慢性肝脏疾病，并带来严重疾病负担。由于缺乏有效的药物，饮食治疗是NAFLD最基础也是最重要的方法。但对于如何实施营养治疗，开展效果监测与评价，目前仍欠缺具体指导与规范。目的　探讨实施个体化精准营养治疗及在此基础上加用抗氧化膳食补充剂“葡萄籽提取物”对NAFLD患者的人体成分、肝脏硬度、肝功能及炎症等指标的影响。方法　采用便利抽样法选择2018年4月—2019年7月广东省人民医院营养科及消化科脂肪肝亚专科门诊就诊的NAFLD患者100例为研究对象，按就诊顺序号随机分为饮食治疗组（n=50）和饮食治疗+抗氧化膳食补充剂组（简称：饮食治疗+补充剂组，n=50），饮食治疗组由营养专科医师按“改良限碳限能量低血糖负荷平衡膳食”原则给予患者个体化营养治疗，饮食治疗+补充剂组在饮食治疗组基础上，加用“葡萄籽提取物”2片/d。试验过程中9例患者脱落：饮食治疗组4例，饮食治疗+膳食补充剂组5例，予以剔除。记录患者的性别、年龄、身高、体质量、体质指数（BMI）、颈围、腰围、臀围、身体脂肪重量（FM）、肌肉质量（MM）、基础代谢率（BMR）、内脏脂肪等级（VFR）、肝脏硬度、受控衰减参数（CAP）、丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）、谷氨酰转肽酶（GGT）、三酰甘油（TG）、总胆固醇（TC）、高密度脂蛋白（HDL-C）、游离脂肪酸（FFA）、总25羟基维生素D〔25（OH）D〕、超氧化物歧化酶（SOD）、超敏C反应蛋白（hs-CRP）、脂质蓄积指数（LAP）等指标，并比较两组间及治疗前后有无差异。结果　剔除9例脱漏患者，最终91例患者完成了试验。两组患者治疗后BMI、颈围、腰围、臀围低于治疗前（P<0.05）。饮食治疗组患者治疗后体质量、FM、BMR、VFR、LAP、CAP、ALT、GGT、hs-CRP低于治疗前（P<0.05）；饮食治疗+补充剂组患者治疗后体质量、FM、VFR、LAP、肝脏硬度、CAP、ALT、GGT、TG、FFA、hs-CRP低于治疗前，HDL-C、SOD高于治疗前（P<0.05）。饮食治疗+补充剂组患者治疗后FFA低于饮食治疗组，SOD高于饮食治疗组（P<0.05）。结论　由营养医师制定并实施个体化精准营养治疗方案，定期跟踪随访，对NAFLD患者的各项指标的改善有明显作用，加用抗氧化膳食补充剂对改善NAFLD患者血脂代谢，降低FFA，升高SOD方面与饮食治疗有协同作用。

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