Padrão dietético habitual na doença hepática gordurosa não-alcoólica

Abstract

Background & aims: Non-alcoholic fatty liver disease (NAFLD) can be associated with the metabolic syndrome (MS), which is influenced by dietary intake. The aims of this study were to investigate the dietary pattern in a Brazilian group of patients with NAFLD and compare the data to the current recommendation Dietary Reference Intakes; to evaluate the usual intake of servings of food groups and compare it with the food guide for Brazilians; and to contrast the findings between the patients with or without the MS. Methods: a cross-sectional study was conducted including prospectively patients diagnosed with NAFDL (American Gastroenterological Association criteria), before the dietetic counseling. Ninety-six patients (77% women; mean age 54±10 years) underwent abdominal ultrasound (US), liver biopsy (according to clinical judgment), biochemical tests, and dietary and anthropometric evaluations. Food intake was assessed by a semi-quantitative food-frequency questionnaire (FFQ) and a 24-hour dietary recall (24h-RD). Results: Twenty-eight percent of the subjects were overweight (BMI> 26kg/m²), and 68% were obese (BMI> 30kg/m²). Usual intake of total fat, saturated fatty acids, omega-6 fatty acids, omega-3 fatty acids and energy exceeded the recommendations. A small proportion of patients also exceed the tolerable upper limit intake for magnesium, sodium and niacin. In contrast, monounsaturated and polyunsaturated fatty acids, and fiber intake were lower than the amount recommended. The following micronutrients intake did not meet the recommendations in a large proportion of patients: calcium, sodium, potassium, pyridoxine and vitamin C. However, the amount of sodium added to the meals was not assessed by the FFQ and the 24-h RD. Additionally, the patients with NAFLD presented a high intake of meats, fats, sugars, beans and vegetables; and, a low intake of cereals, fruits and dairy products when compared with the food guide for Brazilians. The patients with the MS presented a body mass index (33.1±4.0 vs. 30.1±4.9kg/m²; p=0.002), and a waist circumference (104.9±10.4 vs 97.3±12.2cm; p=0.002) higher than those without the MS. On the other hand, they had a similar mean number of food groups servings intake. The differences found in the dietary patterns between the groups with and without the MS were related to the recent intake of protein, energy and iron, which were higher in the patients without MS. MS patients had a lower prolonged intake of retinol and thiamine. Conclusions: NAFLD patients presented a low recent and prolonged intake of monounsaturated fatty acids, polyunsaturated fatty acids, fibers, sodium, calcium, vitamin C and pyridoxine and higher intake of total fat, saturated fatty acids, omega-6 fatty acids, omega-3 fatty acids and energy. MS patients presented higher waist circumference and BMI, and more frequency of diabetes, insulin resistance, hypertriglyceridemia, hypertension, low levels of HDL and higher levels of VLDL when compared with those without MS. The possible role of each nutrient deficient intake in the development of NAFLD should be further investigated