A Carbohydrate-restricted Diet to Reverse Fatty Liver in Adolescents With Obesity

NAFLD is the most common form of liver disease in children in the United States. Currently,
there is no treatment for NAFLD. In adults, weight loss through caloric restriction is
commonly recommended to improve fatty liver. Weight loss is particularly difficult for
children to achieve and significant caloric restriction may not be a prudent recommendation
in developing children and adolescents. Because of this difficulty with weight loss in
children, many children go on to develop cirrhosis and eventually undergo liver transplant.
Data on the effectiveness of diet to reverse fatty liver and prevent progression to cirrhosis
in children is urgently needed. To date, no studies have been done examining how changes in
diet composition without intentional caloric restriction influences NAFLD in children. Data
from previous studies in adults support the hypothesis that consumption of lower-CHO,
higher-fat food sources rich in high-quality proteins and essential fatty acids has
beneficial effects on metabolic health in adults without restricting calories. This study
aims to test the hypothesis that a low CHO higher- fat diet will induce rapid reversal of
fatty liver while also depleting of total and abdominal adiposity, preserving lean mass, and
reducing inflammation in adolescents with obesity and NAFLD.

Inclusion Criteria:

- Overweight/obese (BMI over the 85th percentile) male and female adolescents (age range
10-17) with elevated serum aminotransferase levels, diffusely echogenic liver via
ultrasound suggestive of fatty liver, and/or prior diagnosis of NAFLD. Participant
eligibility will depend on the ability of one parent to attend the initial diet
instruction and individual counselling sessions with the registered dietitian during
week 2, 4 and 6 of the diet intervention.

Exclusion Criteria:

- Presence of hepatic virus infections (HCV RNA-polymerase chain reaction negative;
hepatitis A, B, C, D, E, and G; cytomegalovirus; and Epstein-Barr virus), alcohol
consumption, history of parenteral nutrition, and use of drugs known to induce
steatosis (for example, valproate, amiodarone, or prednisone) or to affect body weight
and carbohydrate metabolism. Autoimmune liver disease, metabolic liver disease, and
Wilson's disease will be ruled out by the participants physician prior to enrollment
in the study.