A Hypocaloric High-Protein Diet Supplemented with β-Cryptoxanthin Improves Non-Alcoholic fatty liver disease: A randomized controlled trial

Abstract

Background: Despite promising animal data, there is no randomized controlled trial (RCT) on the effects of high protein (HP)-diet and/or β-cryptoxanthin in non-alcoholic fatty liver disease (NAFLD).Aims: Safety and efficacy assessment of a hypocaloric HP-diet supplemented with β-cryptoxanthin in NAFLD.Methods: Ninety-two Iranian NAFLD outpatients were recruited for this 12-week, single-center, parallel-group, double-blind RCT and randomized into 4 arms (n=23): HP-diet & β-cryptoxanthin (hypocaloric HP-diet + β-cryptoxanthin), HP-diet (hypocaloric HP-diet + placebo), β-cryptoxanthin (standard hypocaloric diet + β-cryptoxanthin), and control (standard hypocaloric diet + placebo). Serum levels of liver enzymes and grade of hepatic steatosis were assessed at baseline and study endpoint as outcome measures.Results: In the intention-to-treat population (N=92), HP-diet & β-cryptoxanthin group experienced greater 12-week reductions in serum levels of liver enzymes than control group (mean difference for alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, and gamma-glutamyl transferase: -27.2, -7.2, -39.2, and -16.3 IU/L, respectively; all p<0.010). Clinical remission rate (achieving grade 0 hepatic steatosis) in HP-diet & β-cryptoxanthin group (82.6%) was also higher than other groups (13.0%, 17.4%, and 0.0% in HP-diet, β-cryptoxanthin, and control groups, respectively; p<0.001). Sixteen patients reported minor adverse events.Conclusion: A hypocaloric HP-diet supplemented with β-cryptoxanthin safely and efficaciously improves NAFLD.Trial registration number: This trial was registered at http://www.irct.ir as IRCT2017060210181N10.