저탄수화물-고지방 다이어트와 지방간의 관계; 통념과 진실
Association between a High-fat Low-carbohydrate Diet and Non-alcoholic Fatty Liver Disease: Truth or Myth?
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체중조절을 위해 어떠한 식이요법이, 어떤 종류의 음식을섭취하는 것이 같은 칼로리를 섭취함에도 건강에 보다 효과적인지에 대한 질문은 수천 억짜리 질문이며, 동시에 지난 수십 년간 의학분야에서 아직 해결하지 못한 과제 중 하나다. 지금까지 많은 전문가들은 고지방 식단에 의한 비만 및 심혈관 질환의 위험성을 지적해왔으며 에너지밀도가 높은 고지방 과다섭취에 대하여 경고를 하였다. 현재까지 대부분의 전문가 집단은 체중 감소를 위한 특별한 식이패턴은 없으며, 식이패턴보다는 총 에너지 섭취량을 감소하는 것이 체중 감소및 대사 질환의 위험성을 낮출 수 있다고 권고하고 있다. 그러나 최근 국내에서 언론과 미디어를 통하여 탄수화물을극단적으로 제한하고, 대신 고지방 음식을 제한 없이 섭취하는 이른바 ‘저탄수화물-고지방식이(low-carbohydrate high-fat diet)’가 체중감량에 효과적일 수 있다라는 내용이 소개되면서대중의 저탄수화물-고지방식이에 대한 관심이 높아졌다. 한편, 비알코올지방간질환은 비만 및 식생활습관과 밀접한 연관을 가지는 질병이다. 비알코올지방간질환은 최근 비만 인구의 증가에 따라 유병률이 급격하게 증가하고 있으며 우리나라 인구의 약 20-30%가 비알코올지방간질환을동반하고 있다고 알려져 있다[1]. 비알코올지방간질환은 현재 우리나라를 비롯한 서구에서 만성 간질환의 가장 흔한 원인이며, 비알코올지방간질환은 당뇨, 심혈관계 질환 및 전체사망률을 높이는 만성 질환이다. 그러나 아직까지 입증된 치료약물이 없으며 현재까지 식생활습관을 통한 체중 감소가현재 유일하게 인정받은 치료 방법이다[2]. 이에 본 연제에서는 저탄수화물-고지방식이에 관련된 이슈에 대해 알아보고 해당 식이요법이 체중 감소 및 비알코올지방간질환의 관계에 대해 이야기하고자 한다.
Abstract
Reducing caloric intake is important for weight loss and obesity; a reduction of ~500-700 kcal/day has been recommended previously. However, only a minority of individuals can successfully sustain such a reduced caloric intake. Therefore, many specialized diet programs have been proposed. Until now, many experts have recommended low-fat diets in various countries, but very-low-carbohydrate diets have recently garnered attention in Korea. The various effects of changing the dietary compositions of macro- and micronutrients have been debated. The majority of large-scale studies have demonstrated that total caloric intake, rather than the composition of macronutrients or the consumption of a specialized diet, is important for successful weight loss. While many cross-sectional studies have investigated specialized diet programs for patients with non-alcoholic liver disease, no randomized controlled studies have been performed, except for some that investigated the effect of high consumption of unsaturated fatty acids as part of the Mediterranean diet.
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