Rapid Hepatic Function Improvement with Culturally Adapted Low-Carbohydrate Paleolithic Diet in South Asian Adults with Metabolic Dysfunction: A 12-Week Prospective Study with Predictive Modeling

Hariharan Venkatasubramanian 1 * , Vijayasamundeeswari Chinnathambipalayam Kandaswamy 1
More Detail
1 Department of Biochemistry, Vinayaka Mission's Kirupananda Variyar Medical College, Vinayaka Mission's Research Foundation (Deemed to be University), Tamil Nadu, India
* Corresponding Author
J CLIN MED KAZ, Volume 22, Issue 6, pp. 73-79. https://doi.org/10.23950/jcmk/17414
OPEN ACCESS 332 Views 47 Downloads
Download Full Text (PDF)
Author Contributions: Conceptualization, H.V. and V.C.K.; methodology, H.V. and V.C.K.; validation, H.V. and V.C.K.; formal analysis, H.V.; investigation, H.V.; resources, V.C.K.; data curation, H.V.; writing – original draft preparation, H.V.; writing – review and editing, H.V. and V.C.K.; visualization, H.V.; supervision, V.C.K.; project administration, H.V.; funding acquisition – not applicable. All authors have read and agreed to the published version of the manuscript.

Data availability statement: The corresponding author can provide the data supporting the study's conclusions upon request. Due to ethical and privacy constraints, the data are not publicly accessible.

Artificial Intelligence (AI) Disclosure Statement: AI-Unassisted Work.

ABSTRACT

Background: Non-alcoholic fatty liver disease (NAFLD) affects 25-30% of South Asian adults, with limited predictive tools for dietary intervention success. Identifying baseline predictors of hepatic response could enable personalized treatment approaches.
Objective: To evaluate hepatic function benefits of culturally adapted low-carbohydrate Paleolithic diet in South Asian adults with metabolic dysfunction and develop predictive models for treatment response.
Methods: 103 overweight/obese South Asian adults followed a culturally adapted Paleolithic diet for 12 weeks. Primary outcomes were hepatic function improvements (ALT, ALP, hepatic steatosis index). Multiple regression analysis identified predictors of hepatic response. ROC analysis determined optimal baseline cutoffs for treatment success, defined as ≥20% ALT reduction.
Results: Significant hepatic improvements occurred: ALT decreased 17.1% (p<0.05), ALP decreased 7.4% (p<0.01), hepatic steatosis index improved 10.7% (p<0.01). Multiple regression revealed baseline ALT (β=0.58, p<0.001), insulin resistance (β=0.34, p<0.01), and triglycerides (β=0.28, p<0.05) as independent predictors of hepatic response (R²=0.64). ROC analysis showed baseline ALT >28.5 U/L had 81.3% sensitivity and 74.6% specificity for predicting treatment success (AUC=0.82, p<0.001). Concurrent benefits included 9.4kg weight loss and 41% insulin resistance improvement.
Conclusion: Culturally adapted Paleolithic diet produces rapid hepatic function improvements in South Asian adults, with baseline ALT >28.5 U/L predicting optimal treatment response. These findings enable personalized intervention strategies for NAFLD management.

CITATION

Venkatasubramanian H, Chinnathambipalayam Kandaswamy V. Rapid Hepatic Function Improvement with Culturally Adapted Low-Carbohydrate Paleolithic Diet in South Asian Adults with Metabolic Dysfunction: A 12-Week Prospective Study with Predictive Modeling. J CLIN MED KAZ. 2025;22(6):73-9. https://doi.org/10.23950/jcmk/17414

REFERENCES

  • Teng ML, Ng CH, Huang DQ, Chan KE, Tan DJ, Tan C, Lim WH, Yang JD, Tan E, Muthiah M, Siddiqui MS, Sanyal AJ, Loomba R, Wang JW, Nah B, Huang R, Schwabe RF, Lim SG, Carey WB, Noureddin M, Lim KH, Ngoh CL, Mak LY, Yuen MF, Seto WK, Kulkarni AV, Singh SP, Dan YY, Goh GBB, Dhanasekaran R, Low HM, Leong J, Wong VWS, Singal AK, Mahady SE, Nakajima A, Lee KS, Chan WK, Targher G, Duseja A, George J, Chawla Y. Global incidence and prevalence of nonalcoholic fatty liver disease. Clinical and Molecular Hepatology. 2023; 29(Suppl): S32-S42. https://doi.org/10.3350/cmh.2022.0365
  • Shalimar, Elhence A, Bansal B, Gupta H, Anand A, Vishnu VY, Kalaivani M, Bhatia V, Srivastava DN, Garg PK, Datta Gupta S. Prevalence of Non-alcoholic Fatty Liver Disease in India: A Systematic Review and Meta-analysis. Journal of Clinical and Experimental Hepatology. 2022; 12(3): 818-829. https://doi.org/10.1016/j.jceh.2021.11.010
  • Choudhuri G, Shah S, Kulkarni A, Sachdeva S, Roy A, Dhiman RK, Venugopal K, Shalimar, Duseja A, Wadhawan M, Chawla Y, Mishra P, Mukherjee A, Saraf N, Eapen CE, Jain D, Benjamin J, Saraya A, Tandon R, Rathi P. Non-alcoholic Steatohepatitis in Asians: Current Perspectives and Future Directions. Cureus. 2023; 15(8): e42852. https://doi.org/10.7759/cureus.42852
  • Premkumar M, Anand AC. Lean Fatty Liver Disease: Through Thick and Thin. Journal of Clinical and Experimental Hepatology. 2021; 11(5): 523-527. https://doi.org/10.1016/j.jceh.2021.06.011
  • Mohan V, Unnikrishnan R, Shobana S, Malavika M, Anjana RM, Sudha V. Are excess carbohydrates the main link to diabetes & its complications in Asians? Indian Journal of Medical Research. 2018; 148(5): 531-538. https://doi.org/10.4103/ijmr.IJMR_1698_18
  • Redman LM, Heilbronn LK, Martin CK, de Jonge L, Williamson DA, Delany JP, Ravussin E. Metabolic and behavioral compensations in response to caloric restriction: implications for the maintenance of weight loss. PLoS One. 2009; 4(2): e4377. https://doi.org/10.1371/journal.pone.0004377
  • Kandula NR, Bernard V, Dave S, Patel M, Seguil P, Talegawkar S, Shah N, Kang A, Saucedo L, Venkatraman R, Bharucha A, Narayan KMV, Prabhakaran D, Shah NS. The South Asian Healthy Lifestyle Intervention (SAHELI) trial: Protocol for a mixed-methods, hybrid effectiveness implementation trial for reducing cardiovascular risk in South Asians in the United States. Contemporary Clinical Trials. 2020; 92: 105995. https://doi.org/10.1016/j.cct.2020.105995
  • Keating SE, Chawla Y, De A, George ES. Lifestyle intervention for metabolic dysfunction-associated fatty liver disease: a 24-h integrated behavior perspective. Hepatology International. 2024; 18(Suppl 2): 959-976. https://doi.org/10.1007/s12072-024-10663-9
  • Puri P, Dhiman RK, Taneja S, Tandon P, Valsan A, Duseja A, Eapen CE, Venkataraman J, Govil A, Gupta N, Merh N, Merh N, Chaudhary A, Singh SP, Amarapurkar DN, Benjamin J, Kalro RH. Nutrition in Chronic Liver Disease: Consensus Statement of the Indian National Association for Study of the Liver. Journal of Clinical and Experimental Hepatology. 2021; 11(1): 97-143. https://doi.org/10.1016/j.jceh.2020.09.003
  • Yaghoubi F, Darand M, Vasmehjani AA, Dastan S, Hajipour A, Yaghoubi S, Goodarzi-Khoigani M, Hosseinzadeh M. Adherence to low carbohydrate diets and non-alcoholic fatty liver disease: a case control study. BMC Nutrition. 2022; 8(1): 140. https://doi.org/10.1186/s40795-022-00625-5
  • Senn S. Mastering variation: variance components and personalised medicine. Statistics in Medicine. 2016; 35(7): 966-977. https://doi.org/10.1002/sim.6739
  • Sadr H, Nazari M, Khodaverdian Z, Alavi MA, Moghaddam AA, Zarrabi A, Sharifi E, Falahati M, Varma RS, Rabiee N. Unveiling the potential of artificial intelligence in revolutionizing disease diagnosis and prediction: a comprehensive review of machine learning and deep learning approaches. European Journal of Medical Research. 2025; 30(1): 418. https://doi.org/10.1186/s40001-025-02680-7
  • Yu HS, Jiang H, Li MK, Wu YY, Li C, Zhou YJ, Qi YN, Yang YL, Wang XJ, Jiang W, Yuan X, Pan Q, Zhang RN, Fan JG. Lowering the threshold of alanine aminotransferase for enhanced identification of significant hepatic injury in chronic hepatitis B patients. World Journal of Gastroenterology. 2023; 29(35): 5166-5177. https://doi.org/10.3748/wjg.v29.i35.5166
  • Friedman SL, Neuschwander-Tetri BA, Rinella M, Sanyal AJ. Mechanisms of NAFLD development and therapeutic strategies. Nature Medicine. 2018; 24(7): 908-922. https://doi.org/10.1038/s41591-018-0104-9
  • Smith GI, Shankaran M, Yoshino M, Schweitzer GG, Chondronikola M, Beals JW, Okunade AL, Patterson BW, Nyangau E, Field T, Sirlin CB, Talukdar S, Hellerstein MK, Klein S. Insulin resistance drives hepatic de novo lipogenesis in nonalcoholic fatty liver disease. Journal of Clinical Investigation. 2020; 130(3): 1453-1460. https://doi.org/10.1172/JCI134165
  • Verbakel JY, Steyerberg EW, Uno H, De Cock B, Wynants L, Collins GS, Van Calster B. ROC curves for clinical prediction models part 1. ROC plots showed no added value above the AUC when evaluating the performance of clinical prediction models. Journal of Clinical Epidemiology. 2020; 126: 207-216. https://doi.org/10.1016/j.jclinepi.2020.01.028
  • Albhaisi S, Chowdhury A, Sanyal AJ. Non-alcoholic fatty liver disease in lean individuals. JHEP Reports. 2019; 1(4): 329-341. https://doi.org/10.1016/j.jhepr.2019.08.002
  • Amare F, Kiflu A, Taddese A. Effects of concurrent continuous aerobic and short rest resistance exercise training on metabolic biomarkers in type 2 diabetes patients: a systematic review and meta-analysis. Diabetology & Metabolic Syndrome. 2025; 17(1): 290. https://doi.org/10.1186/s13098-025-01838-x
  • Roumeliotis S, Schurgers LJ, Tsalikakis DG, Georgianos PI, Liakopoulos V, Eleftheriadis T, Thodis E, Mayer G, Stamatelou K. ROC curve analysis: a useful statistic multi-tool in the research of nephrology. International Urology and Nephrology. 2024; 56(8): 2651-2658. https://doi.org/10.1007/s11255-024-04022-8