Two week protein-enriched low-calorie diet (Hepafast) shows rapid improvement of fatty liver as assessed by controlled attenuation parameter

Fatty liver (FL) is one of the most prevalent liver disorders, which increases the risk of fibrosis and cirrhosis. FL occurs frequently in patients with diabetes. The aim herein was to assess for therapeutic effects of a short-term dietary intervention on FL, as quantified using the controlled attenuation parameter (CAP).

Sixty-six patients with FL received a 14-day low-calorie liver-specific diet containing 800 kcal/day (HEPAFAST: 41% protein, 29% carbohydrates, 24% fat, 6% fiber) and a maximum of 200 kcal/day through vegetable intake. The following parameters were assessed pre- and post-intervention: liver fat contents using the CAP algorithm during transient elastography; body composition with bioimpedance analysis; serum liver function tests and lipids using standard clinical-chemical assays.

All 66 patients (median age 56 years [25 – 78], 52% women, median BMI 31.7 kg/m2 [22.4 – 46.3]) successfully completed the study. A significant reduction in FL (14.3%; P < 0.001) was observed after only 2 weeks; median CAP score decreased from 296 dB/m (177 – 400) at baseline to 264 dB/m (100 – 353). Simultaneously, BMI decreased by 5%, 32% of the patients were reclassified into a lower BMI category, and body fat and visceral fat contents decreased by 7%. Serum triglyceride, total LDL and GGT also decreased (all P < 0.001). Interestingly, 11 patients (73% women) demonstrated a CAP increase after the intervention despite improvements in body composition, thus were classified as hepatic non-responders. A subgroup analysis of the responders revealed a decrease of 17% in median CAP scores from 311 to 263 dB/m. When comparing diabetics with non-diabetics (24% vs. 76%), equal improvements of liver fat, body composition, serum liver function tests and lipid profiles were observed (all P > 0.05).

This non-invasive elastography-based study demonstrates for the first time improvements in liver fat, as quantified by CAP, after a short-term protein-enriched low-calorie diet. The dietary intervention reduced body weight and improved body as well as liver composition in both diabetics and non-diabetics alike.