Impact of very-low-carbohydrate diet on cardiovascular risk in patients with metabolic associated fatty liver disease based on the China-PAR model

Junjie ZHANG; Shanshan PI; Jinyan DENG; Ziyu WU; Yue LI; Qian WANG; Hongbo DU

doi:10.12449/JCH251214

Volume 41 Issue 12

Dec. 2025

Turn off MathJax

Article Contents

Article Navigation > Journal of Clinical Hepatology > 2025 > 41(12): 2528-2535

PDF( 705 KB)

Impact of very-low-carbohydrate diet on cardiovascular risk in patients with metabolic associated fatty liver disease based on the China-PAR model

DOI: 10.12449/JCH251214

Junjie ZHANG^{1, 2},
Shanshan PI^{1, 2},
Jinyan DENG^{1, 2},
Ziyu WU^{1, 2},
Yue LI^{1, 2},
Qian WANG^{1, 2},
Hongbo DU^{1, 3
,
,
,}

1.
Department of Gastroenterology，Dongzhimen Hospital，Beijing University of Chinese Medicine，Beijing 100700，China
2.
The First Clinical Medical College of Beijing University of Chinese Medicine，Beijing 100029，China
3.
Institute of Liver Diseases，Beijing University of Chinese Medicine，Beijing 100700，China

Research funding:

Capital’s Funds for Health Improvement and Research (2024-2-4195);

The National Administration of Traditional Chinese Medicine Letter (［2022］-1)

More Information

Corresponding author: DU Hongbo， duhongbotcm@126.com （ORCID： 0000-0002-5797-1399）
Received Date: 2025-06-26
Accepted Date: 2025-08-27
Published Date: 2025-12-25

Abstract

Abstract

Objective To investigate the effectiveness and safety of very-low-carbohydrate diet （VLCD） in the treatment of metabolic associated fatty liver disease （MAFLD） by observing its impact on various indicators， and to provide a basis for clinical treatment. Methods This single-center retrospective single-arm cohort study was conducted among 103 patients who were diagnosed with MAFLD in Dongzhimen Hospital， Beijing University of Chinese Medicine， from September 2021 to May 2024， and all patients received the VLCD intervention regimen for 2 — 6 weeks. Related indicators were compared before and after treatment， including body weight， body mass index （BMI）， liver controlled attenuation parameter （CAP）， fasting plasma glucose （FPG）， fasting serum C-peptide （C-P）， fasting serum insulin （FINS）， Homeostasis Model Assessment of Insulin Resistance （HOMA-IR）， total cholesterol （TC）， triglycerides （TG）， high-density lipoprotein cholesterol （HDL-C）， and low-density lipoprotein cholesterol （LDL-C）. Finally， the China-PAR cardiovascular risk prediction model was used to calculate the risk of cardiovascular events before and after treatment and evaluate the impact of this dietary intervention on cardiovascular health. The paired t-test or the Wilcoxon signed-rank test was used for comparison of continuous data between groups. Results After VLCD treatment， there were significant reductions in body weight， BMI， and CAP （Z=-8.515， -8.495， and -8.204， all P <0.001）， and there were significant improvements in FPG， FINS， C-P， and HOMA-IR （Z=-4.215， -5.310， -4.482， and -5.422， all P<0.001）. There was a significant reduction in TG after treatment （Z=-5.373， P<0.001）. The China-PAR model showed significant reductions in the 10-year and lifetime risk assessment indices of cardiovascular disease in 103 patients （Z=-5.406 and -5.383， both P<0.001）. The subgroup analysis based on sex showed that in the male group， there were significant differences in body weight， BMI， CAP， FPG， FINS， C-P， HOMA-IR， TG， blood pressure， waist circumference， and the risk of cardiovascular disease before and after treatment （all P<0.05）， while in the female group， there were significant reductions in body weight， BMI， CAP， FPG， FINS， C-P， HOMA-IR， TC， TG， LDL-C， blood pressure， waist circumference， and the risk assessment of cardiovascular disease （all P<0.05）. The subgroup analysis based on age showed that in the youth group， there were significant reductions in body weight， BMI， CAP， FPG， FINS， C-P， HOMA-IR， TG， systolic blood pressure， waist circumference， and the risk assessment of cardiovascular disease （all P<0.05）； in the middle-aged group， there were significant reductions in body weight， BMI， CAP， FPG， FINS， C-P， HOMA-IR， TG， systolic blood pressure， diastolic blood pressure， waist circumference， and the risk assessment of cardiovascular disease （all P<0.05）； in the elderly group， there were significant reductions in body weight， BMI， CAP， systolic blood pressure， waist circumference， and the risk assessment of cardiovascular disease （all P <0.05）. After treatment， there were 43 patients with an increase in TC （41.7%）， 24 patients with an increase in TG （23.3%）， and 43 patients with an increase in LDL-C （41.7%）； 53 patients （51.5%） showed a reduction in HDL-C； 9 patients （8.7%） showed an increase in CAP； 26 patients （25.2%） had an increase in HOMA-IR. Conclusion VLCD can effectively alleviate fatty liver disease and reduce insulin resistance in the treatment of MAFLD， without increasing the risk of cardiovascular disease.
- Metabolic Associated Fatty Liver Disease,
- Diet， Carbohydrate-Restricted,
- Cardiovascular Diseases

FullText(HTML)

References(26)

References

[1]	CHAN WK, CHUAH KH, RAJARAM RB, et al. Metabolic dysfunction-associated steatotic liver disease(MASLD): A state-of-the-art review[J]. J Obes Metab Syndr, 2023, 32( 3): 197- 213. DOI: 10.7570/jomes23052.
[2]	AU K, ZHENG MH, LEE WJ, et al. Resmetirom and metabolic dysfunction-associated steatohepatitis: Perspectives on multidisciplinary management from global healthcare professionals[J]. Curr Obes Rep, 2024, 13( 4): 818- 830. DOI: 10.1007/s13679-024-00582-z.
[3]	MIAO L, TARGHER G, BYRNE CD, et al. Current status and future trends of the global burden of MASLD[J]. Trends Endocrinol Metab, 2024, 35( 8): 697- 707. DOI: 10.1016/j.tem.2024.02.007.
[4]	LE MH, LE DM, BAEZ TC, et al. Global incidence of non-alcoholic fatty liver disease: a systematic review and meta-analysis of 63 studies and 1 201 807 persons[J]. J Hepatol, 2023, 79( 2): 287- 295. DOI: 10.1016/j.jhep.2023.03.040.
[5]	ESLAM M, FAN JG, YU ML, et al. The Asian Pacific association for the study of the liver clinical practice guidelines for the diagnosis and management of metabolic dysfunction-associated fatty liver disease[J]. Hepatol Int, 2025, 19( 2): 261- 301. DOI: 10.1007/s12072-024-10774-3.
[6]	SETHI S, WAKEHAM D, KETTER T, et al. Ketogenic diet intervention on metabolic and psychiatric health in bipolar and schizophrenia: A pilot trial[J]. Psychiatry Res, 2024, 335: 115866. DOI: 10.1016/j.psychres.2024.115866.
[7]	KANWAL F, NEUSCHWANDER-TETRI BA, LOOMBA R, et al. Metabolic dysfunction-associated steatotic liver disease: Update and impact of new nomenclature on the American Association for the Study of Liver Diseases practice guidance on nonalcoholic fatty liver disease[J]. Hepatology, 2024, 79( 5): 1212- 1219. DOI: 10.1097/hep.00000000000-00670.
[8]	PAPADOPOULOU SK, NIKOLAIDIS PT. Low-carbohydrate diet and human health[J]. Nutrients, 2023, 15( 8): 2004. DOI: 10.3390/nu15082004.
[9]	CAREY RM, WHELTON PK. Prevention, detection, evaluation, and management of high blood pressure in adults: Synopsis of the 2017 American college of cardiology/American heart association hypertension guideline[J]. Ann Intern Med, 2018, 168( 5): 351- 358. DOI: 10.7326/m17-3203.
[10]	ROMERO-GÓMEZ M, CORTEZ-PINTO H. Detecting liver fat from viscoelasticity: How good is CAP in clinical practice? The need for universal cut-offs[J]. J Hepatol, 2017, 66( 5): 886- 887. DOI: 10.1016/j.jhep.2017.01.029.
[11]	YANG XL, LI JX, HU DS, et al. Predicting the 10-year risks of atherosclerotic cardiovascular disease in Chinese population: The China-PAR project(prediction for ASCVD risk in China)[J]. Circulation, 2016, 134( 19): 1430- 1440. DOI: 10.1161/circulationaha.116.022367.
[12]	YANAI H, YOSHIDA H. Beneficial effects of adiponectin on glucose and lipid metabolism and atherosclerotic progression: Mechanisms and perspectives[J]. Int J Mol Sci, 2019, 20( 5): 1190. DOI: 10.3390/ijms2005-1190.
[13]	AHMED B, SULTANA R, GREENE MW. Adipose tissue and insulin resistance in obese[J]. Biomed Pharmacother, 2021, 137: 111315. DOI: 10.1016/j.biopha.2021.111315.
[14]	KATTAMURI L, DUGGAL S, APARECE JP, et al. Cardiovascular risk factor and atherosclerosis in rheumatoid arthritis(RA)[J]. Curr Cardiol Rep, 2025, 27( 1): 31. DOI: 10.1007/s11886-025-02198-8.
[15]	ALLAN GM, GARRISON S, MCCORMACK J. Comparison of cardiovascular disease risk calculators[J]. Curr Opin Lipidol, 2014, 25( 4): 254- 265. DOI: 10.1097/mol.0000000000000095.
[16]	DYŃKA D, KOWALCZE K, CHARUTA A, et al. The ketogenic diet and cardiovascular diseases[J]. Nutrients, 2023, 15( 15): 3368. DOI: 10.3390/nu15153368.
[17]	CAO QF, LI H, PAN XY, et al. A systematic review and meta-analysis of the predictive power of China-PAR against cardiovascular disease[J]. Clin Med Res, 2024, 22( 1): 28- 36. DOI: 10.3121/cmr.2024.1846.
[18]	ATHINARAYANAN SJ, HALLBERG SJ, MCKENZIE AL, et al. Impact of a 2-year trial of nutritional ketosis on indices of cardiovascular disease risk in patients with type 2 diabetes[J]. Cardiovasc Diabetol, 2020, 19: 208. DOI: 10.1186/s12933-020-01178-2.
[19]	TAGGART AKP, KERO J, GAN XD, et al.(D)-beta-Hydroxybutyrate inhibits adipocyte lipolysis via the nicotinic acid receptor PUMA-G[J]. J Biol Chem, 2005, 280( 29): 26649- 26652. DOI: 10.1074/jbc.C500213200.
[20]	GUO YZ, ZHANG C, SHANG FF, et al. Ketogenic diet ameliorates cardiac dysfunction via balancing mitochondrial dynamics and inhibiting apoptosis in type 2 diabetic mice[J]. Aging Dis, 2020, 11( 2): 229. DOI: 10.14336/ad.2019.0510.
[21]	CHONG DY, GU YY, ZHANG TY, et al. Neonatal ketone body elevation regulates postnatal heart development by promoting cardiomyocyte mitochondrial maturation and metabolic reprogramming[J]. Cell Discov, 2022, 8: 106. DOI: 10.1038/s41421-022-00447-6.
[22]	LOPEZ-LOPEZ JP, GARCIA-PENA AA, MARTINEZ-BELLO D, et al. External validation and comparison of six cardiovascular risk prediction models in the Prospective Urban Rural Epidemiology(PURE)-Colombia study[J]. Eur J Prev Cardiol, 2025, 32( 7): 564- 572. DOI: 10.1093/eurjpc/zwae242.
[23]	MAKI KC, DICKLIN MR, KIRKPATRICK CF. Saturated fats and cardiovascular health: Current evidence and controversies[J]. J Clin Lipidol, 2021, 15( 6): 765- 772. DOI: 10.1016/j.jacl.2021.09.049.
[24]	CALZOLARI I, FUMAGALLI S, MARCHIONNI N, et al. Polyunsaturated fatty acids and cardiovascular disease[J]. Curr Pharm Des, 2009, 15( 36): 4094- 4102. DOI: 10.2174/138161209789909755.
[25]	ROS E, MARTÍNEZ-GONZÁLEZ MA, ESTRUCH R, et al. Mediterranean diet and cardiovascular health: Teachings of the PREDIMED study[J]. Adv Nutr, 2014, 5( 3): 330S- 336S. DOI: 10.3945/an.113.005389.
[26]	FERHATBEGOVIĆ L, MRŠIĆ D, KUŠLJUGIĆ S, et al. LDL-C: The only causal risk factor for ASCVD. why is it still overlooked and underestimated?[J]. Curr Atheroscler Rep, 2022, 24( 8): 635- 642. DOI: 10.1007/s11883-022-01037-3.

Relative Articles

Supplements(0)

Cited By

Proportional views

Proportional views

通讯作者: 陈斌, bchen63@163.com

1.
沈阳化工大学材料科学与工程学院沈阳 110142

Tables(6)

Get Citation

PDF

XML

Article Metrics

Article views (57) PDF downloads(17)

Impact of very-low-carbohydrate diet on cardiovascular risk in patients with metabolic associated fatty liver disease based on the China-PAR model

DOI: 10.12449/JCH251214

Abstract

References

Proportional views

Catalog

通讯作者: 陈斌, bchen63@163.com

Article Metrics

Proportional views

Related

About Journal

Submission Guideline

Journal Online

Hepatobiliary College

Guidelines

Export File

Citation

Format

Content