{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T13:15:36Z","timestamp":1782738936017,"version":"3.54.5"},"reference-count":61,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2021,2,15]],"date-time":"2021-02-15T00:00:00Z","timestamp":1613347200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004587","name":"Instituto de Salud Carlos III","doi-asserted-by":"publisher","award":["Projects PI14\/00636 and PI17\/01827, and CIBEROBN CB12\/03\/30038, and Proyecto Intramural CIBER OBN18PI03"],"award-info":[{"award-number":["Projects PI14\/00636 and PI17\/01827, and CIBEROBN CB12\/03\/30038, and Proyecto Intramural CIBER OBN18PI03"]}],"id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Fundacio La Marat\u00f3 TV3","award":["201630.10"],"award-info":[{"award-number":["201630.10"]}]},{"name":"Health Department of the Government of Navarra","award":["61\/2015"],"award-info":[{"award-number":["61\/2015"]}]},{"DOI":"10.13039\/501100008530","name":"European Regional Development Fund","doi-asserted-by":"publisher","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}],"id":[{"id":"10.13039\/501100008530","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Balearic Islands Government","award":["35\/2011 and 23\/2012"],"award-info":[{"award-number":["35\/2011 and 23\/2012"]}]},{"DOI":"10.13039\/501100000921","name":"COST","doi-asserted-by":"publisher","award":["CA16112"],"award-info":[{"award-number":["CA16112"]}],"id":[{"id":"10.13039\/501100000921","id-type":"DOI","asserted-by":"publisher"}]},{"name":"IDISBA","award":["FOLIUM, PRIMUS, SYNERGIA, and LIBERI"],"award-info":[{"award-number":["FOLIUM, PRIMUS, SYNERGIA, and LIBERI"]}]},{"name":"Spanish Ministry of Education","award":["Catalina M. Mascar\u00f3 received an FPU PhD Grant"],"award-info":[{"award-number":["Catalina M. Mascar\u00f3 received an FPU PhD Grant"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>To assess the efficacy of three lifestyle interventions on the reduction of liver fat content and metabolic syndrome (MetS), and whether such reductions would influence renal outcomes, we conducted a randomized controlled trial on 128 participants with MetS and non-alcoholic fatty liver disease (NAFLD), as well as available data on estimated glomerular filtration rate (eGFR) and urinary albumin-to-creatine ratio (UACR). Patients were randomized in 1:1:1 ratio to either Conventional Diet, Mediterranean diet (MD)\u2013high meal frequency, and MD\u2013physical activity groups. Each intervention aimed at reducing caloric intake by 25%\u201330% of baseline intake and increase energy expenditure by 400 kcal\/70 kg. Patients attended regular visits and were followed-up for 6 months. Increased albuminuria was present in 13.3% of patients, while 32.8% showed hyperfiltration. UACR reduction was associated with higher levels of UACR at baseline but not with changes in liver fat. eGFR decreased in patients presenting hyperfiltration at baseline and was associated with reduction in liver fat and insulin resistance, as well as with increase in energy expenditure (R2 = 0.248, p = 0.006). No significant differences were observed between the three treatment groups. In patients with NAFLD and MetS, energy expenditure significantly reduced hepatic fat accumulation and insulin resistance, which reduced glomerular hyperfiltration. Increased albuminuria was reduced, but it was not associated with reduced liver fat.<\/jats:p>","DOI":"10.3390\/nu13020629","type":"journal-article","created":{"date-parts":[[2021,2,15]],"date-time":"2021-02-15T22:58:01Z","timestamp":1613429881000},"page":"629","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":26,"title":["Energy Expenditure Improved Risk Factors Associated with Renal Function Loss in NAFLD and MetS Patients"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9905-2414","authenticated-orcid":false,"given":"Manuela","family":"Abbate","sequence":"first","affiliation":[{"name":"Research Group in Community Nutrition and Oxidative Stress, University Research Institute of Health Sciences (IUNICS), University of the Balearic Islands, 07122 Palma de Mallorca, Spain"},{"name":"Health Research Institute of Balearic Islands (IdISBa), 07120 Palma de Mallorca, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catalina M.","family":"Mascar\u00f3","sequence":"additional","affiliation":[{"name":"Research Group in Community Nutrition and Oxidative Stress, University Research Institute of Health Sciences (IUNICS), University of the Balearic Islands, 07122 Palma de Mallorca, Spain"},{"name":"Health Research Institute of Balearic Islands (IdISBa), 07120 Palma de Mallorca, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sof\u00eda","family":"Montemayor","sequence":"additional","affiliation":[{"name":"Research Group in Community Nutrition and Oxidative Stress, University Research Institute of Health Sciences (IUNICS), University of the Balearic Islands, 07122 Palma de Mallorca, Spain"},{"name":"Health Research Institute of Balearic Islands (IdISBa), 07120 Palma de Mallorca, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda","family":"Barber\u00eda-Latasa","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine and Public Health, University of Navarra, 31008 Pamplona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miguel","family":"Casares","sequence":"additional","affiliation":[{"name":"Radiodiagnosis Service, Red Asistencial Juaneda, 07011 Palma de Mallorca, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina","family":"G\u00f3mez","sequence":"additional","affiliation":[{"name":"Clinical Analysis Service, University Hospital Son Espases, 07120 Palma de Mallorca, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Escarlata","family":"Angullo-Martinez","sequence":"additional","affiliation":[{"name":"Research Group in Community Nutrition and Oxidative Stress, University Research Institute of Health Sciences (IUNICS), University of the Balearic Islands, 07122 Palma de Mallorca, Spain"},{"name":"Health Research Institute of Balearic Islands (IdISBa), 07120 Palma de Mallorca, Spain"},{"name":"Escola Graduada Primary Health Care Center, 07002 Palma de Mallorca, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Tejada","sequence":"additional","affiliation":[{"name":"Research Group in Community Nutrition and Oxidative Stress, University Research Institute of Health Sciences (IUNICS), University of the Balearic Islands, 07122 Palma de Mallorca, Spain"},{"name":"Health Research Institute of Balearic Islands (IdISBa), 07120 Palma de Mallorca, Spain"},{"name":"CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6475-5387","authenticated-orcid":false,"given":"Itziar","family":"Abete","sequence":"additional","affiliation":[{"name":"CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain"},{"name":"Department of Nutrition, Food Sciences, and Physiology, Center for Nutrition Research, University of Navarra, 31008 Pamplona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3926-0892","authenticated-orcid":false,"given":"Maria Angeles","family":"Zulet","sequence":"additional","affiliation":[{"name":"CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain"},{"name":"Department of Nutrition, Food Sciences, and Physiology, Center for Nutrition Research, University of Navarra, 31008 Pamplona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8656-6838","authenticated-orcid":false,"given":"Antoni","family":"Sureda","sequence":"additional","affiliation":[{"name":"Research Group in Community Nutrition and Oxidative Stress, University Research Institute of Health Sciences (IUNICS), University of the Balearic Islands, 07122 Palma de Mallorca, Spain"},{"name":"Health Research Institute of Balearic Islands (IdISBa), 07120 Palma de Mallorca, Spain"},{"name":"CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. Alfredo","family":"Mart\u00ednez","sequence":"additional","affiliation":[{"name":"CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain"},{"name":"Department of Nutrition, Food Sciences, and Physiology, Center for Nutrition Research, University of Navarra, 31008 Pamplona, Spain"},{"name":"Cardiometabolics Precision Nutrition Program, IMDEA Food, CEI UAM-CSIC, 28049 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6940-0761","authenticated-orcid":false,"given":"Josep A.","family":"Tur","sequence":"additional","affiliation":[{"name":"Research Group in Community Nutrition and Oxidative Stress, University Research Institute of Health Sciences (IUNICS), University of the Balearic Islands, 07122 Palma de Mallorca, Spain"},{"name":"Health Research Institute of Balearic Islands (IdISBa), 07120 Palma de Mallorca, Spain"},{"name":"CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,2,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1002\/hep.29367","article-title":"The diagnosis and management of nonalcoholic fatty liver disease: Practice guidance from the American Association for the Study of Liver Diseases","volume":"67","author":"Chalasani","year":"2018","journal-title":"Hepatology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1016\/j.metabol.2012.08.005","article-title":"In patients with non-alcoholic fatty liver disease, metabolically abnormal individuals are at a higher risk for mortality while metabolically normal individuals are not","volume":"62","author":"Younossi","year":"2013","journal-title":"Metabolism"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Musso, G., Gambino, R., Tabibian, J.H., Ekstedt, M., Kechagias, S., Hamaguchi, M., Hultcrantz, R., Hagstr\u00f6m, H., Yoon, S.K., and Charatcharoenwitthaya, P. 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