Carbohydrate-Restricted Diet Superior to Low-Calorie Diet for Reducing Hepatic Triglyceride Content in Children With NAFLD

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Investigators compared a carbohydrate-restricted diet with a low-calorie diet to determine which more effectively reduced hepatic triglyceride content in children with nonalcoholic fatty liver disease.

A carbohydrate-restricted diet (LCarb) was found to significantly decrease hepatic triglyceride content after 2 months compared with a low-calorie diet (LCal) in children and adolescents with nonalcoholic fatty liver disease (NAFLD), according to findings from a pilot study presented at The Liver Meeting Digital Experience.

The randomized controlled trial included 18 children aged 11 to 17 years with biopsy-proven NAFLD and metabolic syndrome (Mets). Half of the participants were randomly assigned to the LCarb diet, which consisted of 20% carbohydrates, 35% protein, and 45% fat. The other half received the LCal diet (50% carbohydrates, 20% protein, and 30% fat).

All participants received nutritional education and behavioral counseling. The families prepared their own meals. Dietary compliance was ensured by monthly phone calls and 72-hour dietary recall completed by a registered dietitian. The families with a pediatric gastroenterologist and psychologist on a monthly basis;  they also met with a registered dietitian in a clinic every other month for 6 months.

The investigators measured hepatic triglyceride content quantified by proton magnetic resonance spectroscopy (MRS), alanine aminotransferase (ALT), body mass index (BMI), and patient percentage of body fat at baseline and at 2 and 6 months of dietary intervention.

The mean age of the LCal group (SD, 13.7 ± 1.7 years) was comparable to that of the LCarb group (SD, 13.4 ± 1.7 years). The LCal group had a slightly lower mean BMI (SD, 31.2 ± 3.5 kg/m2) than the LCarb group (SD, 32.7 ± 2.3 kg/m2). All 18 participants were Hispanic; most were male.

The study authors found that participants in the LCarb group reduced their carbohydrate intake by 7% at 2 months and 9% at 6 months of dietary intervention. The BMI z-score did not differ statistically between the 2 diet groups during the 6-month study period.

The percent change from baseline in hepatic triglyceride content measured by proton MRS was significantly greater in the LCarb group compared with the LCal group at 2 months (-24.5 vs -2.8 percentage points, respectively, P =.02). However, at 6 months, the change from baseline was not significantly different between the 2 diet groups (LCarb, -29.9 vs LCal, -9.1, P =.43).

“A trend toward a decrease in ALT was observed in the LCarb group at 2 months, which persisted at 6 months,” the researchers noted. Additionally, the percentage of body fat was not found to differ between the 2 groups.

“Participants in the LCarb group were able to decrease their overall carbohydrate intake by 7%, which was enough to show a significant decrease in hepatic triglyceride content of 24.5% after 2 months in comparison to the LCal group,” the investigators concluded. “Findings in this study are preliminary, but a carbohydrate-restricted diet should be considered as a short-term intervention for obese children and adolescents with NAFLD and metabolic syndrome.”

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Panganiban J, Blondet N, Kozlitina J, et al. Carbohydrate-restricted diet lowers hepatic triglyceride (TG) in obese children and adolescents with non-alcoholic fatty liver disease (NALFD) and metabolic syndrome (Met-s). Poster presented at: The Liver Meeting Digital Experience; November 13-16, 2020. P1716.