Critical appraisal for low-carbohydrate diet in nonalcoholic fatty liver disease: Review and meta-analyses

Background & aims: Weight loss by lifestyle modification is the cornerstone therapy of Non Alcoholic Fatty Liver Disease. Low carbohydrate diet has showed favorable effects for body weight as well as hepatic fat content in several reports. In this meta-analysis, we review clinical studies article to date regarding the composition of the diet and analyzed the impact of low carbohydrate diet comparing to low calorie diet on hepatic fat change, AST and ALT using Forest plot. We aimed to investigate the efficacy of low carbohydrate diet on NAFLD. Methods: We collected studies that were conducted with various amounts of carbohydrate and different methods for changing the hepatic fat and fibrosis. Results: Eleven clinical studies (seven randomized controlled trials) were selected on the efficacy and safety of low carbohydrate diet on NAFLD patients. Four studies evaluated hepatic fat by magnetic resonance imaging and two evaluated hepatic fat using computed tomography. However, the pools of subjects were small, the criterion for low carbohydrate was variable, and there is yet an established standard method of evaluation of liver. In meta-analysis, there was no significant difference between low carbohydrate diet group and low fat diet group on the improvement of hepatic fat content and transaminases in NAFLD. Conclusion: So far there's little evidence that low-carbohydrate diet has more beneficial effect on NAFLD than low calorie diet in similar calorie intake. (C) 2018 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.