Background: NAFLD has emerged as the most common liver disease among adolescents in industrialized countries. Results from trials in adults with NAFLD suggest that reducing CHO intake may deplete liver fat to a greater extent than other dietary approaches, even when there was no difference in weight loss between diet groups. The objective of this study was to determine the effects of a CHO-restricted vs. fat-restricted diet in adolescents with NAFLD on reduction in hepatic lipid and insulin resistance.

Methods: Twenty-three adolescents (age 9-17) with obesity (BMI ≥85th percentile) and confirmed NAFLD were randomized to a CHO-restricted (<10:25:>65% energy from CHO:protein:fat) or fat-restricted diet (55:25:20) for 8 weeks. Caloric intakes were calculated to be weight maintaining. Participants and one parent attended bi-weekly counselling with a registered dietitian. To encourage compliance, groceries were delivered to participants’ families during the first 2 weeks of the study. Both diets included minimally processed foods with limited added sugar. Change in hepatic lipid content was measured via MRI, body composition via DXA, and insulin resistance via a fasting blood sample.

Results: After 8 weeks, the CHO-restricted diet group experienced a significant decrease in hepatic lipid content (-6.0±4.7%, p<0.001), whereas the fat-restricted diet group showed no change. We found significantly greater decreases in insulin resistance (HOMA-IR, -1.2±5.1, <0.05), abdominal fat mass (-1.7 ±1.1 kg, p<0.01), and body fat mass (-3.1±4.0 kg, p<0.01) in response to the CHO-restricted vs. fat-restricted diet.

Conclusion: The CHO-restricted diet approach may be markedly beneficial in improving fatty liver, body composition, and insulin resistance in adolescents with NAFLD even in the absence of intentional caloric restriction. Practitioners should consider recommending this diet approach to effectively improve disease course in this patient population.


A.M. Goss: None. S. Dowla: None. A.P. Ashraf: Research Support; Self; Opko. Speaker's Bureau; Spouse/Partner; Bristol-Myers Squibb Company, Celgene Corporation, Insys, Pfizer Inc. M. Bolding: None. S.A. Morrison: None. B. Gower: None.


National Institute of Diabetes and Digestive and Kidney Diseases; Thrasher Research Fund

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