Status: Funded - Open
A carbohydrate-restricted diet to reverse fatty liver in adolescents with obesity
Amy Goss, PhD, RD
BACKGROUND: With increasing prevalence of childhood obesity, non-alcoholic fatty liver disease (NAFLD) has emerged as the most common cause of liver disease among children and adolescents in industrialized countries. NAFLD in children, as in adults, is associated with obesity and metabolic syndrome. The pathogenesis of NAFLD in children is not fully understood, but is thought to involve complex interactions between alterations in nutrient metabolism, insulin resistance, and the onset of inflammation in multiple organ systems. While the principal existing therapies target the metabolic disorders associated with fatty liver, no treatment currently exists to directly reverse hepatic fat infiltration.
GAP: Lifestyle modifications such as a caloric restriction and exercise represent the mainstay of therapy for NAFLD in children. However, no recommendations exist on the appropriate and most effective macronutrient composition of the prescribed diet. Reducing intake of carbohydrate sources such as added sugars, high glycemic grains, and fructose may be the most effective approach to reverse fatty liver by significantly reducing insulin resistance, inflammation, and hepatic de novo lipogenesis. Therefore, the objective of this application is to test the effects of a reduced-carbohydrate vs reduced-fat diet in overweight/obese adolescents on reversal of fatty liver, inflammation, and insulin resistance.
HYPOTHESIS: Carbohydrate restriction compared to standard reduced-fat approach will induce rapid reversal of fatty liver in obese adolescents with NAFLD.
METHODS: Two-arm, parallel design with 40 overweight/obese adolescents (Tanner stage ≥4, age range 13-17) with elevated serum aminotransferase levels and diffusely echogenic liver via ultrasound randomized to a carbohydrate restricted diet or a reduced-fat diet for 8 weeks. Anthropometric/metabolic evaluations will occur at baseline, week 2, week 6, and week 8.
IMPACT: Results will be a first step towards developing evidence-based dietary recommendations as a part of standard of care in the treatment of children presenting with NAFLD.