Metabolic Flexibility, Gut Microbiota, Healthy Diet and Exercise in NAFLD on Genetics Base
Condition: Non-alcoholic Fatty Liver Disease; Obesity
MeSH terms: Liver Diseases; Fatty Liver; Non-alcoholic Fatty Liver Disease
Study type: Interventional

Summary: 
      Nonalcoholic fatty liver disease (NAFLD) is associated to obesity, metabolic syndrome and
      genetic predisposition: specific variants of the genes PNPLA3 and TM6SF2 are the most
      involved. Also biochemical mechanisms that affect the "metabolic flexibility" need to be
      better clarified.

      It is known that a dietary intervention, accompanied by a physical personalized training,
      reduce either the hepatic fat content either insulin resistance.

      Therefore, the aim of the study is to evaluate "metabolic flexibility" in obese NAFLD
      subjects taking in account the presence or absence of PNPLA3 and TM6SF2 polymorphism and the
      histopathological diagnosis of either simple steatosis or nonalcoholic steatohepatitis
      (NASH). The composition of gut microbiota will be also evaluated.

      Finally, two distinct healthy dietary profiles accompanied by a personalized physical
      training, will be tested to comprehend whether and how "healthy diets" could operate in the
      clinical treatment of NAFLD and related conditions.
    

Detailed description: 
      Nonalcoholic fatty liver disease (NAFLD) is frequently associated to obesity and metabolic
      syndrome. In NAFLD, a heritable component to disease susceptibility has been demonstrated:
      the variants of the genes PNPLA3 and TM6SF2 are the most involved genetic determinants.

      To date, biochemical mechanisms that affect the "metabolic flexibility" in obese NAFLD
      subjects, in presence or absence of genetic susceptibility, need to be better clarified.

      Different studies demonstrated that a dietary intervention, accompanied by a physical
      personalized training, significantly reduce either the hepatic fat content either insulin
      resistance in overweight and obese subjects, independently of weight loss.

      On these bases, the aim of the study is to evaluate "metabolic flexibility" in obese NAFLD
      subjects taking in account their genetics (presence or absence of PNPLA3 and TM6SF2
      polymorphisms) and the histopathological diagnosis of either simple steatosis or nonalcoholic
      steatohepatitis (NASH). In addition, the composition of gut microbiota will be evaluated.

      Finally, in this study, two distinct healthy dietary profiles accompanied by a personalized
      physical training, will be tested in order to comprehend whether and how "healthy diets"
      could be effective not only in the prevention, but also in the clinical treatment of NAFLD
      and other related conditions.
    

Intervention name(s): Mediterranean diet; Low fat diet; Aerobic exercise
Intervention type(s): Dietary Supplement; Dietary Supplement; Other
Intervention description(s): In the Mediterranean diet fat intake will be equal to 35% of the total energy intake minus carbohydrate and protein energy carbohydrate as 65% of total calorie intake, dietary cholesterol <300 mg/day, dietary fiber 25 g/day.; In the hypocaloric low fat diet, fat will represent less than 25% of the total energy intake. Branched and essential amino acids will be administered taking into account the total protein intake.; A personalized program of aerobic exercise will be prescribed to the participants of both arms, following the "FITT" principles (frequency, intensity, time and type).
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Nonalcoholic fatty liver disease (NAFLD) is associated to obesity, metabolic syndrome and genetic predisposition: specific variants of the genes PNPLA3 and TM6SF2 are the most involved. Also biochemical mechanisms that affect the "metabolic flexibility" need to be better clarified.
It is known that a dietary intervention and a physical personalized training, reduce either the hepatic fat content either insulin resistance.
Therefore, the aim of the study is to evaluate "metabolic flexibility" in obese NAFLD subjects taking in account the presence or absence of PNPLA3 and TM6SF2 polymorphism and the histopathological diagnosis of either simple steatosis or nonalcoholic steatohepatitis (NASH). The composition of gut microbiota will be also evaluated.
Finally, two distinct healthy dietary profiles accompanied by a personalized physical training, will be tested to comprehend whether and how "healthy diets" could operate in the clinical treatment of NAFLD and related conditions.
Masking: None (Open Label)
Primary purpose: Basic Science