Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD)
Conditions
Keywords
MASLD, Diet modification, DASH Diet
Brief summary
Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) in childhood is becoming increasingly prevalent, paralleling the rise in obesity rates, and has become the most common chronic liver disease in the pediatric population. MASLD is associated with metabolic mechanisms such as insulin resistance, dyslipidemia, oxidative stress, and inflammation, and can progress to serious complications like steatohepatitis, fibrosis, and cirrhosis in later stages. Currently, pharmacological treatments for managing MASLD are limited, and lifestyle modifications, particularly dietary interventions, stand out as the primary approach for preventing and treating the disease. In this context, the composition of macro and micronutrients plays a critical role in the development and progression of hepatic steatosis. Within this framework, the Dietary Approaches to Stop Hypertension (DASH) diet is a balanced eating pattern that encourages the consumption of vegetables, fruits, whole grains, legumes, low-fat dairy products, fish, poultry, and healthy fat sources, while limiting sodium, saturated fat, sugary foods, and processed meat products. Similar to the Mediterranean diet, the DASH diet is a promising approach for conditions like metabolic syndrome and MASLD due to its anti-inflammatory potential, its reducing effect on oxidative stress, and its properties that enhance insulin sensitivity. Furthermore, thanks to its high fiber content, it contributes to balancing the gut microbiota and supports the production of short-chain fatty acids (SCFAs), which in turn have positive effects on liver and metabolic health. Evaluated in terms of fat intake, the DASH diet's emphasis on foods rich in n-3 fatty acids (such as fish and walnuts) provides an anti-inflammatory effect, while limiting saturated and trans fats offers an important strategy for reducing hepatic fat accumulation. Additionally, restricting the consumption of added sugars and fructose may be effective in preventing hepatic steatosis by suppressing lipogenesis processes. In light of all these scientific findings, considering the impact of dietary patterns on the development and progression of MASLD, appropriately structuring the diet is critically important for protecting liver health in children. Accordingly, an anti-inflammatory, antioxidant, and metabolically balanced DASH dietary model is considered an effective and applicable approach in the management of pediatric MASLD. Within the scope of this study, the effects of implementing the DASH diet in children with MASLD on clinical and metabolic parameters such as liver enzymes, degree of hepatic steatosis, insulin resistance, lipid profile, and inflammatory markers will be evaluated compared to a control group. Additionally, by examining the relationships between these parameters and quality of life as well as dietary adherence, the potential therapeutic role of the DASH diet in the management of pediatric MASLD will be elucidated.
Interventions
OTHERDASH Diet
The DASH diet is structured with a macronutrient distribution of 50-55% carbohydrates, 16-18% protein, and 27-30% fat. The diet plan recommends high intake of fruits, vegetables, low-fat dairy products, oilseeds, legumes, and whole grains, as well as low intake of sodium, sugary foods, and red and processed meats.
OTHERStandart Diet
The standard diet is planned so that 45-60% of energy comes from carbohydrates, 25-35% from fats, and 15-20% from proteins. The standard diet is based on the healthy eating recommendations for children in the 2022 Turkish Nutrition Guide (TÜBER). Unlike the DASH diet, the standard diet allows the consumption of refined grains, full-fat milk and meat products, and simple sugars not exceeding 10% of energy.
OTHERPhysical Activity
The home-based exercise program aims to increase physical activity. The exercise program is planned as 30 minutes x 5 days a week, under parental supervision or with parental guidance. Participants will be instructed to begin their workout with 10 minutes of warm-up exercises (push-ups, sit-ups, reverse sit-ups, squats, aerial cycling, stretching), continue with 15 minutes of aerobic activities (jump rope, step aerobics, dancing, throwing a ball against a wall, running up and down stairs), and conclude with 5 minutes of cool-down exercises (stretching).
Sponsors
Antalya Training and Research Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
The study was designed as a randomized, parallel-assigned dietary intervention without blinding (open-label) because blinding the diets was impractical.
Eligibility
Sex/Gender
ALL
Age
11 Years to 18 Years
Healthy volunteers
No
Inclusion criteria
* Eligibility criteria include being between 11 and 18 years of age, * Having a body mass index (BMI) ≥95th percentile, * Having hepatic steatosis detected by magnetic resonance imaging (MRI) and proton density fat fraction (PDFF) measurement (cutoff value ≥5%).
Exclusion criteria
* Other liver diseases (such as viral hepatitis, autoimmune hepatitis, Wilson's disease), * Alcohol consumption, * History of type I or type II diabetes, * Use of medications that may affect fatty liver or blood lipid profile (corticosteroids, metformin, vitamin E, omega-3 fatty acids, etc.), * Having participated in a weight loss program or undergone bariatric surgery prior to the study, * Presence of chronic inflammatory disease, thyroid dysfunction (hyperthyroidism and hypothyroidism), * Having received antibiotic treatment and used nutritional supplements in the last 3 months prior to the study, * Having a psychiatric disorder that may affect adherence to the diet or the safety of exercise.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in hepatic steatosis percentage | 12 weeks | Comparison of the change in hepatic steatosis percentage, as measured by MRI-PDFF, in diet groups over 12 weeks. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Changes in insulin resistance | 12 weeks | The insulin resistance index will be calculated using the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) formula. |
| Changes in anthropometric measurements | 12 weeks | Participants will wear light clothing, and their body weight (BW) will be recorded to the nearest 100g using a Seca scale. Height measurements will be taken with participants standing barefoot against a wall, ensuring proper alignment of the head, shoulders, pelvis, and heels. Weight will be measured in kilograms, and height in meters, and weight and height will be combined to report Body Mass Index (BMI) in kg/m². BMI will be calculated by dividing BW (kg) by the square of their height (m²) (kg/m²). |
| Changes in fibrosis index | 12 weeks | Changes in the Pediatric Non-alcoholic fatty liver disease Fibrosis Index (PNFI) score will be evaluated. The PNFI is a scale ranging from 0 to 10, with higher scores indicating a worse outcome (i.e., more severe liver fibrosis). This index is calculated based on age, waist circumference, and triglyceride levels, as developed and validated by Nobili et al. (2009). |
Contacts
CONTACTUlas Emre Akbulut, Assoc. Prof.
Outcome results
None listed