DOI: 10.1111/hepr.13954 ISSN:

Moderate‐carbohydrate diet without caloric or lipid restriction for Japanese adult patients with nonalcoholic fatty liver disease: A prospective cohort study

Hideyuki Tamai, Jumpei Okamura, Kishio Nanjo
  • Infectious Diseases
  • Hepatology



Although a low‐calorie diet with lipid restriction is recommended in clinical practice guidelines for nonalcoholic fatty liver disease (NAFLD), both compliance and adherence are poor. The present study aimed to evaluate the compliance, adherence, and effectiveness of a moderate‐carbohydrate diet without caloric or lipid restrictions.


Participants comprised 300 patients with NAFLD with elevated ALT levels who received counseling in carbohydrate restriction (150–200 g/day). Complete response (CR) was defined as ALT normalization and partial response as a ≥30% reduction in ALT from baseline without CR.


Dropout rates were 3% (10 of 300) after 6 months and 8% (23 of 300) after 12 months. Achievement rates of carbohydrate intake ≤200 g/day after 1, 3, 6, and 12 months were 80%, 81%, 80%, and 73%, respectively. CR and partial response rates were 60% and 31% after 6 months, and 65% and 25% after 12 months, respectively. Rates of achieving a ≥7% weight reduction after 6 and 12 months were 51% and 49%, respectively. Significant reductions in percentage body fat and visceral fat area were obtained, along with a significant increase in liver/spleen attenuation ratio. Serum lipids, uric acid, homeostatic model assessment for insulin resistance, hemoglobin A1c, C‐reactive protein, ferritin, immunoglobulin, blood cell, shear wave velocity in the liver, and Mac‐2‐binding protein glycosylated isomers all decreased significantly.


Compliance and adherence to a moderate‐carbohydrate diet without caloric or lipid restriction is high. The sustained high effectiveness of this therapy would improve the pathophysiological state of NAFLD.

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