Premium
A high glycemic index diet: a contribution to the pathogenesis of childhood NAFLD?
Author(s) -
Mager Diana R,
Rogenstein Carly D,
Roberts Eve A
Publication year - 2006
Publication title -
the faseb journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.709
H-Index - 277
eISSN - 1530-6860
pISSN - 0892-6638
DOI - 10.1096/fasebj.20.5.a857-a
Subject(s) - insulin resistance , medicine , hyperinsulinemia , endocrinology , glycemic index , nonalcoholic fatty liver disease , steatosis , insulin , fatty liver , glycemic , disease
Nonalcoholic fatty liver disease (NAFLD; hepatic large‐droplet steatosis ± inflammation ± fibrosis) can cause serious liver disease in children. Most children with NAFLD have elevated BMI; some have elevated serum aminotransferases and hyperlipidemia. Hyperinsulinemia with variable insulin resistance appears to be a critical feature of disease mechanism. Our hypothesis is dietary pattern elicits hyperinsulinemia and contributes to the hepatic disease process. We prospectively studied 20 children clinically diagnosed with NAFLD. Body composition, liver biochemistries, fasting glucose, insulin, and lipid profiles were obtained. Insulin resistance was assessed using the homeostasis model of insulin resistance (HOMA‐IR). Three‐day food intake records were collected to assess the nutrient content of the diet. Mean age (±SD) of study participants was 14.1 (±3.1) yrs. 14 out of 20 children were obese (BMI: 29.9 ±5.5). Patients had elevations of ALT (117 ± 98 U/L), triglycerides (1.9 ± 0.6 mmol/L) and HOMA‐IR scores (>2) consistent with insulin resistance. HOMA‐IR scores correlated to increased plasma triglycerides (p=0.02), BMI (p=0.006), dietary glycemic index (p=0.04) and sucrose intake (p=0.05). Diets were high in saturated fat (11.6% ± 2.3), glycemic load (137.2 ±42.9) and low in polyunsaturated fat (4.6% ± 2.3), vitamin E (4.4 ± 3.6 mg) and fiber (14.7 ± 5.6). Children with NAFLD consume a diet that generates a metabolic environment leading to insulin resistance. Nutritional strategies aimed at lowering dietary glycemic index and sucrose intake represent a physiologically based intervention for childhood NAFLD. (Supported by CIHR/CAG/Nestle).