Hepatic Steatosis
Conditions
Keywords
non-alcoholic fatty liver disease, steatohepatitis, overweight, insulin resistance
Brief summary
There has been a recent increase in incidence of obesity and its associated morbidities, including T2 DM, hypertension and hepatic steatosis. Hepatic steatosis is a precursor to non-alcoholic steatohepatitis, cirrhosis and end-stage liver disease. The 1st reported case of pediatric hepatic steatosis was in 1980 and it is now affects 30-77% of overweight children. In addition to its association with obesity, hepatic steatosis has been associated with the metabolic syndrome, insulin resistance, and post-prandial hyperglycemia. Current treatment of hepatic steatosis includes weight loss with a hypocaloric low fat diet. Given the association with insulin resistance and post-prandial hyperglycemia, adult patients with hepatic steatosis that does not respond to weight loss are placed on insulin sensitizing drugs. We hypothesize that weight loss with a diet designed to decrease insulin resistance and post-prandial hyperglycemia, a low glycemic load diet, will provide a safe and effective way to decrease hepatic fat content in the pediatric population. This hypothesis will be tested with a randomized control trial comparing the effect of a low fat diet with a low glycemic load diet.
Interventions
Outpatient behavioral counseling
Outpatient behavioral counseling
Sponsors
Study design
Eligibility
Inclusion criteria
* BMI \>95th percentile for age and sex * Weight \<300 pounds * Ability to lie quietly in the MRI for approximately 45 minutes * Willing and able to attend all sessions. * Working telephone * Greater than or equal to 10% hepatic steatosis on nMR spectroscopy
Exclusion criteria
* Any other medical condition besides obesity that may predispose to liver disease * Medications that affect liver metabolism * Any causes of chronic hepatitis * Diabetes * Inability to adhere to prescribed diets * Currently on high-dose vitamins and not willing to discontinue * Weight loss/gain in the past 6 months of \>10% of total body weight. * Sibling of any subject who is already enrolled * Any alcohol consumption
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| percent liver fat as determined by nMR spectroscopy | 6 months |
Secondary
| Measure | Time frame |
|---|---|
| visceral fat | 6 months |
| liver function tests | 6 months |
| measures of oxidative stress | 6 months |
| measures of chronic inflammation | 6 months |
| insulin resistance | 6 months |
| hepatic steatosis as measured by T1 weighted MRI images | 6 monhts |
| blood pressure | 6 months |
| insulin secretion | baseline |
| measures of glucose tolerance | 6 months |
| adiponectin | 6 months |
| serum lipids | 6 months |
Countries
United States