Effects of Weight Loss on Hepatic and Muscle Lipid Content and on Insulin Sensitivity on Obese Adolescents With NAFLD

Study Overview
=================
Brief Summary
-----------------
To assess whether reversal of fatty liver by moderate weight loss (8% of body weight) will lead to improvements in insulin sensitivity, which will be associated with changes in both glucose status and lipid profiles, in obese children and adolescents with fatty liver who have normal glucose or pre-diabetes.

Detailed Description
-----------------
This study will have two groups: one group that eats a moderate calorie, low-fat diet and is weighed regularly (every other week for 16 weeks) and the other who receives traditional diet therapy and returns in 16 weeks. Both groups will undergo procedures that test glucose tolerance and measure liver and muscle fat content before and after study period.

Official Title
-----------------
Effects of Weight Loss on Hepatic and Muscle Lipid Content and on Insulin Sensitivity on Obese Adolescents With NAFLD

Conditions
-----------------
Fatty Liver, Insulin Resistance

Intervention / Treatment
-----------------
* Other: Low-fat diet
* Other: Traditional diet


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: 10 to 21 yrs of age Non-smoking BMI >95th percentile for age and gender, but BMI <40 Suspicion of fatty liver, with a high ALT (>35) Normal glucose tolerance or prediabetes (impaired glucose tolerance or impaired fasting glucose) Exclusion Criteria: Females of child-bearing potential who are not using birth control Pregnant or lactating females Current medications except oral anti-diabetic medications and hormonal birth control Lipid-lowering medication that increases liver enzymes Significant kidney dysfunction (creatinine >1.5 mg/dL) Current heavy ethanol use or recent history of binge drinking History or evidence of hepatitis A, B, or C, Wilson's Disease, or alpha-1-antitrypsin deficiency Known to be HIV positive Symptomatic angina pectoris or cardiac insufficiency as defined by the NYHA classification as Functional Class III or IV Major vascular event within 6 months of screening (e.g. MI, stroke) Active cancer within 5 years prior to screening Current systemic disease, including type 1 or 2 diabetes Enrolled in another research study within 1 month prior to screening Implanted paramagnetic material (all subjects will need to fill out the Yale Magnetic Resonance Center safety checklist) Anemia (HCT <35%)

Ages Eligible for Study
-----------------
Minimum Age: 10 Years
Maximum Age: 21 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
Accepts Healthy Volunteers

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Low-fat diet<br>20% kcals from fat diet followed for 8 weeks then 8 weeks of maintenance diet with visits to dietitian every other week | Other: Low-fat diet<br>* 20% calorie from fat diet followed for 8 weeks then maintenance diet for additional 8 weeks<br>Other: Traditional diet<br>* Traditional low-fat diet with dietitian follow-up in 16 weeks<br>|
| Active Comparator: Traditional<br>Traditional low-fat diet given and dietitian follows up in 16 weeks | Other: Traditional diet<br>* Traditional low-fat diet with dietitian follow-up in 16 weeks<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Liver Enzyme, liver and muscle fat content, glucose tolerance status |  | 16-18 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| plasma lipid levels |  | 16-18 weeks | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
steatosis, fatty liver, insulin sensitivity, fatty liver (steatosis)