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Abstract Details
Clinical Intervention to Reduce Dietary Sugar does not Impact Liver Fat in Latino Youth, Regardless of PNPLA3 Genotype: A Randomized Controlled Trial
J Nutr. 2022 Feb 26;nxac046. doi: 10.1093/jn/nxac046. Online ahead of print.
Kelsey A Schmidt1, Roshonda B Jones1, Claudia Rios1, Yesica Corona1, Paige K Berger1, Jasmine F Plows1, Tanya L Alderete2, Jennifer Fogel1, Hailey Hampson13, Jaana A Hartiala4, Zhiheng Cai5, Hooman Allayee54, Krishna S Nayak67, Frank R Sinatra3, Gregory Harlan3, Trevor A Pickering4, Sarah-Jeanne Salvy8, Wendy Mack4, Rohit Kohli9, Michael I Goran1
Author information
From the Department of Pediatrics, The Saban Research Institute, Children's Hospital Los Angeles, US.
Department of Integrative Physiology, University of Colorado Boulder, US.
Department of Pediatrics, University of Southern California, US.
Department of Population and Public Health Sciences, University of Southern California, US.
Department of Biochemistry & Molecular Medicine, University of Southern California, US.
Department of Electrical and Computer Engineering, University of Southern California, US.
Department of Biomedical Engineering, University of Southern California, US.
Cancer Research Center for Health Equity, Cedars-Sinai Medical Center, US.
Department of Pediatrics and Division of Gastroenterology and Hepatology, Children's Hospital Los Angeles, US.
Abstract
Background: Non-alcoholic fatty liver disease (NAFLD) among Latinos is partially attributed to a prevalent C > G polymorphism in the patatin-like phospholipase 3 (PNPLA3) gene. Cross-sectional analyses in Latino children showed the association between dietary sugar and liver fat was exacerbated by GG genotype. Pediatric feeding studies show extreme sugar restriction improves liver fat, but no prior trial has examined the impact of a clinical intervention or whether effects differ by PNPLA3 genotype.
Objectives: To test effects of a clinical intervention to reduce dietary sugar versus standard dietary advice on change in liver fat, and secondary-endpoints changes in liver fibrosis, liver enzymes and anthropometrics; and whether effects differ by PNPLA3 genotype (assessed retrospectively) in Latino youth with obesity (BMI ≥ 95th percentile).
Design: This parallel-design trial randomized participants [n = 105; 12.7% baseline liver fat, 14.8 yrs] to control or sugar reduction (goal of ≤ 10% of calories from free sugar) for 12-weeks. Intervention participants met with a dietitian monthly and received delivery of bottled water. Changes in liver fat, by magnetic resonance imaging, were assessed by intervention group through general linear models.
Results: Free sugar intake decreased in intervention compared to control [11.5 to 7.3% vs. 13.9 to 10.7% (% Energy) respectively, P = 0.02], but there were no significant effects on liver outcomes or anthropometrics (pall > 0.10), and no PNPLA3 interactions (pall > 0.10). In exploratory analyses, participants with whole-body fat mass reduction (-1.9 ± 2.42.4 kg), irrespective of randomization, had significant reductions in liver fat compared to participants without fat mass reduction [-2.1% (-6.5, -0.8) vs. 0.3% (-1.0, 2.2), P < 0.001].
Conclusions: In Latino youth with obesity, a dietitian-led sugar reduction intervention did not improve liver outcomes compared to control, regardless of PNPLA3 genotype. Results suggest fat mass reduction is important for liver fat reduction, confirming clinical recommendations of weight loss and a healthy diet for pediatric NAFLD.