Please select the eligibility criteria that correspond to the clinical trial below.
Title: Effects of Fructose Restriction on Liver Steatosis
Brief Summary: Nonalcoholic fatty liver disease (NAFLD) is an emerging health problem as it can lead to end stage liver failure and cardiovascular complications. Diet play an important role in the development of NAFLD. Many studies have addressed the effects of added fructose on NAFLD. To date, little attention has been paid to the effects of a diet devoid of fructose. Therefore, the investigators aim to study the effects of fructose restriction on hepatic fat accumulation and vascular function using a double-blind randomized placebo-controlled design.


Options:
A: Inclusion Criteria:

* BMI \>95th percentile for age and sex
* Weight \<300 pounds
* Ability to lie quietly in the MRI for approximately 45 minutes
* Willing and able to attend all sessions.
* Working telephone
* Greater than or equal to 10% hepatic steatosis on nMR spectroscopy

Exclusion Criteria:

* Any other medical condition besides obesity that may predispose to liver disease
* Medications that affect liver metabolism
* Any causes of chronic hepatitis
* Diabetes
* Inability to adhere to prescribed diets
* Currently on high-dose vitamins and not willing to discontinue
* Weight loss/gain in the past 6 months of \>10% of total body weight.
* Sibling of any subject who is already enrolled
* Any alcohol consumption
B: Inclusion Criteria:

* Overweight/obese (BMI over the 85th percentile) male and female adolescents (age range 10-17) with elevated serum aminotransferase levels, diffusely echogenic liver via ultrasound suggestive of fatty liver, and/or prior diagnosis of NAFLD. Participant eligibility will depend on the ability of one parent to attend the initial diet instruction and individual counseling sessions with the registered dietitian during week 2, 4 and 6 of the diet intervention.

Exclusion Criteria:

* Presence of hepatic virus infections (HCV RNA-polymerase chain reaction negative; hepatitis A, B, C, D, E, and G; cytomegalovirus; and Epstein-Barr virus), alcohol consumption, history of parenteral nutrition, and use of drugs known to induce steatosis (for example, valproate, amiodarone, or prednisone) or to affect body weight and carbohydrate metabolism. Autoimmune liver disease, metabolic liver disease, and Wilson's disease will be ruled out by the participants physician prior to enrollment in the study.
C: Inclusion Criteria:

* Age 18-65 with Nonalcoholic Fatty Liver Disease as determined by MRS

Exclusion Criteria:

* Medical History

  * Diabetes
  * Heart Disease
  * Asthma/Lung disease
  * Injury that prevents exercise
* Social history

  * Drinking
  * More than one drink per day
  * Binge drinking on the weekends (more than 3 or 4 drinks per weekend day)
* Smoking
* It's OK if they were a previous smoker, but they need to have quit more than 6 months ago
* Exercise

  * They must exercise less than one hour per week
  * Medications: must be on stable regimen of ANY medication for at least 3 months
* Beta-Blockers

  * Lipid/cholesterol lowering medications:
  * Oral hypoglycemics (anti-diabetes medications - some like metformin are indicated for pre-diabetes)
* Hormone replacement therapy
* If the woman is pre-menopausal, it is OK if she is on birth control as long as she has been on it over 3 months
* Weight history

  * Weight \<300 lbs
  * BMI 30 to 45
  * Weight stable - \<10lbs weight loss or gain in the last 3 months
D: Inclusion Criteria:

* Age ≥ 18 years
* Body mass index ≥ 28 kg/m2
* Fatty liver index ≥ 60
* Fructose intake ≥45 grams/day

Exclusion Criteria:

* Medical history of liver disease
* (History of) excessive alcohol consumption (defined as \> 2 units/day for women, and \> 3 units/day for men)
* Major change in weight and/or physical activity prior to the study
* Use of glucose lowering drugs
* Recent illness
* Pregnancy and/or lactation
* Contraindications for magnetic resonance imaging
* Inability to give informed consent

Protocol change (implemented on July 18, 2018): in order to increase the inclusion of study participants, subjects with an average daily fructose intake \< 45 gram/day will also be eligible for participation. In subjects who have an average daily fructose intake \< 45 gram/day, supplementation of either fructose or glucose (see 'Arms and Interventions') will be increased to 45 gram/day.

Answer: D