A randomised research found that liver transplant recipients who followed a low-carbohydrate diet (LCD) lost weight and had a better metabolic phenotypic profile.
Mohammad Siddiqui, DO, of Virginia Commonwealth University in Richmond reported that in an interim analysis involving 27 patients, those who followed an LCD had a significantly higher mean weight loss of nearly 8 kg (about 17 lbs) over 6 months, compared to those on a low-calorie restricted diet (CRD), who did not experience any significant weight loss (P=0.01). He claimed in a presentation at the American Association for the Study of Liver Diseases that the LCD had an advantageous impact on patients’ metabophenotype, particularly for fat depots (AASLD).
Patients with obesity have a higher risk of cardiovascular disease and mortality even though weight gain and even obesity are frequent following liver transplantation. It can be quite challenging for liver transplant recipients to lose weight. According to earlier research, these patients have metabolic rigidity, which results in the release of fatty acids into the bloodstream.
Additionally, skeletal muscle is less sensitive to fatty acid oxidation, which leads to fat re-circulation/re-cycling that deposits fat into various organs, lowering mitochondrial efficiency and making weight loss harder, according to him. The trial’s objective, according to Siddiqui, was to determine whether weight loss may be accomplished while also enhancing metabolic flexibility
An LCD (n = 14) with a carbohydrate restriction of 20 grammes per day for 24 weeks was given to the remaining 27 obese liver transplant recipients, who were randomly assigned to either the CRD (n = 13), which involved a total calorie intake of less than 1,200–1,500 per day regardless of macronutrient content, or the CRD (n = 13). The participants were adults with a BMI of at least 30. There was follow-up every two weeks. People with persistent end-organ damage, uncontrolled psychiatric illness, terminal illnesses, people taking weight loss drugs, and other conditions were excluded.
Accelerometry data were evaluated after 7 days to make sure patients continued to exercise at the same rate. The main result measured by common weight scales was a weight change. Several secondary outcomes evaluated metabophenotypes, metabolic flexibility, mitochondrial function, and metabolic risks using tools for whole-body MRI, whole-room calorimetry, respiratory capacity, and lipoproteins/insulin resistance in order to better understand patients’ body physiology with weight change.
The groups’ initial clinical features were comparable. There were 60%–61% men and a median age of 55–56.
The average BMI was 37–40, and non-Hispanic whites made up 60% of the population. Diabetics made up two thirds. Common comorbidities included dyslipidemia (60% vs 50%), non-alcoholic steatohepatitis (NASH; 67% vs 33%), and hypertension (100% vs 89% in the LCD group).
Siddiqui noted that the LCD caused body fat compartments to be reduced more significantly (liver, visceral, subcutaneous, and muscle). Visceral adipose tissue and abdominal subcutaneous adipose tissue, which each showed close to a 20% reduction in the change from baseline, both witnessed a considerable improvement as the LCD group lost weight. Additionally, they showed improvement in liver fat content (almost a 10% decrease) and muscle fat infiltration, but these changes were not statistically significant (P=0.06). Additionally, the LCD group experienced a “very slight” loss in skeletal muscle volume (approximately 5%), but not the CRD group (P 0.01).
The study is still underway, and according to Siddiqui, he predict that these disparities will become even less significant. Both diets were well tolerated at the end of the research and had no discernible impact on renal function.
The LCD had no effect on glomerular filtration rate, blood urea nitrogen, serum creatinine, or serum lipids (total cholesterol, triglycerides, LDL/HDL), renal function levels, or insulin resistance when considering metabolic risk (HbA1c and glucose). However, since the majority of individuals in the LCD group were taken off insulin at enrolment and none of those in the CRD group were, those in the LCD group had a lower insulin dose.
According to Siddiqui, the LCD can possibly increase insulin sensitivity. He stated that his team intends to continue investigating how dietary changes may affect metabolic flexibility. Other crucial areas of research, such atherogenic lipoproteins, to evaluate the use of baseline metabolic flexibility in predicting response to diet.
Reached for comment, Andrew Talal, MD, MPH, of the University at Buffalo in New York, told MedPage Today, “I think that these interim results are encouraging for the potential effectiveness of LCD over caloric restriction, but require caution in drawing any firm conclusions. We await the final results of the trial with interest,” said Talal, who was not involved in this study.
Parvathy Sukumaran 
