title: The effect of a low fructose and low glycemic index/load (FRAGILE) dietary intervention on indices of liver function, cardiometabolic risk factors, and body composition in children and adolescents with nonalcoholic fatty liver disease (NAFLD).
abstract: BACKGROUND
  Nonalcoholic fatty liver disease (NAFLD) is a common liver disease in obese children. Diets high in added fructose (high fructose corn syrup; HFCS) and glycemic index (GI)/glycemic load (GL) are associated with increased risk of NAFLD. Lifestyle modification is the main treatment, but no guidelines regarding specific dietary interventions for childhood NAFLD exist. We hypothesized that reductions in dietary fructose (total, free, and HFCS)/GI/GL over 6 months would result in improvements in body composition and markers of liver dysfunction and cardiometabolic risk in childhood NAFLD.
  
  
  METHODS
  Children and adolescents with NAFLD (n = 12) and healthy controls (n = 14) 7-18 years were studied at baseline and 3 and 6 months post-dietary intervention. Plasma markers of liver dysfunction (ALT, AST, γGT), cardiometabolic risk (TG, total cholesterol, LDL-HDL cholesterol, Apo-B100, Apo-B48, Apo-CIII, insulin, homeostasis model of assessment of insulin resistance [HOMA-IR]), inflammation (TNF-α, IL-6, IL-10), anthropometric, and blood pressure (BP) were studied using validated methodologies.
  
  
  RESULTS
  Significant reductions in systolic BP (SBP), percentage body fat (BF), and plasma concentrations of ALT (P = .04), Apo-B100 (P < .001), and HOMA-IR were observed in children with NAFLD at 3 and 6 months (P < .05). Dietary reductions in total/free fructose/HFCS and GL were related to reductions in SBP (P = .01), ALT (P = .004), HOMA-IR (P = .03), and percentage BF in children with NAFLD. Reductions in dietary GI were associated with reduced plasma Apo-B100 (P = .02) in both groups. With the exception of Apo-B100, no changes in laboratory variables were observed in the control group.
  
  
  CONCLUSIONS
  Modest reductions in fructose (total/free, HFCS) and GI/GL intake result in improvements of plasma markers of liver dysfunction and cardiometabolic risk in childhood NAFLD.
authors: Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton, Alberta, Canada Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada mager@ualberta.ca.
authors: Diana R
authors: DR
authors: Mager
authors: Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton, Alberta, Canada.
authors: Ingrid Rivera
authors: IR
authors: Iñiguez
authors: Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
authors: Susan
authors: S
authors: Gilmour
authors: Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
authors: Jason
authors: J
authors: Yap
mesh_terms: D000293:Adolescent; D001794:Blood Pressure; D001823:Body Composition; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D002648:Child; D002149:Energy Intake; D005260:Female; D005632:Fructose / Q000008:administration & dosage / Q000009:adverse effects*; D038321:Glycemic Index; D006801:Humans; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance; D016753:Interleukin-10 / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D008099:Liver / Q000503:physiopathology*; D008297:Male; D024821:Metabolic Syndrome / Q000453:epidemiology*; D009043:Motor Activity; D065626:Non-alcoholic Fatty Liver Disease / Q000503:physiopathology*; D015596:Nutrition Assessment; D009765:Obesity / Q000150:complications / Q000503:physiopathology; D011446:Prospective Studies; D012307:Risk Factors; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
chemical_list: D007328:Insulin; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha; D016753:Interleukin-10; D005632:Fructose
keywords: children; glycemic index; glycemic load; high fructose corn syrup; metabolic dysregulation; nonalcoholic fatty liver disease