Nonalcoholic fatty liver disease (NAFLD) is a major cause of chronic liver disease, characterized by hepatic fat accumulation and possible development of inflammation, fibrosis, and cancer. The ketogenic diet (KD), with its drastic carbohydrate reduction, is a now popular weight loss intervention, despite safety concerns on a possible association with fatty liver. However, KDs were also reported to be beneficial on hepatic pathology, with ketone bodies recently proposed as effective modulators of inflammation and fibrosis. If the beneficial impact of weight loss on NAFLD is established, less is known on the effect of macronutrient distribution on such outcome. In a hypocaloric regimen, the latter seems not to be crucial, whereas at higher calorie intake, macronutrient ratio and, theoretically, ketosis, may become important. KDs could positively impact NAFLD for their very low carbohydrate content, and whether ketosis plays an additional role is unknown. Indeed, several mechanisms may directly link ketosis and NAFLD improvement, and elucidating these aspects would pave the way for new therapeutic strategies. We herein aimed at providing an accurate revision of current literature on KDs and NAFLD, focusing on clinical evidence, metabolic pathways involved, and strict categorization of dietary interventions.

中文翻译：

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生酮饮食对非酒精性脂肪肝的有益作用：文献综合综述。


非酒精性脂肪肝病 (NAFLD) 是慢性肝病的主要原因，其特征是肝脏脂肪堆积，并可能发展为炎症、纤维化和癌症。尽管生酮饮食（KD）可能与脂肪肝有关，但由于其碳水化合物含量大幅减少，因此成为目前流行的减肥干预措施。然而，据报道，酮体也对肝脏病理学有益，最近提出酮体是炎症和纤维化的有效调节剂。如果减肥对 NAFLD 的有益影响已确定，那么常量营养素分布对此类结果的影响却知之甚少。在低热量治疗方案中，后者似乎并不重要，而在较高热量摄入下，常量营养素比例以及理论上的酮症可能变得重要。 KD 因其碳水化合物含量极低而可能对 NAFLD 产生积极影响，而酮症是否发挥额外作用尚不清楚。事实上，有几种机制可能直接将酮症和 NAFLD 的改善联系起来，阐明这些方面将为新的治疗策略铺平道路。我们在此旨在对当前有关 KD 和 NAFLD 的文献进行准确修订，重点关注临床证据、涉及的代谢途径以及饮食干预的严格分类。