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Panera N, Barbaro B, Della Corte C, Mosca A, Nobili V, Alisi A. A review of the pathogenic and therapeutic role of nutrition in pediatric nonalcoholic fatty liver disease. Nutr Res 2018; 58:1-16. [DOI: 10.1016/j.nutres.2018.05.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 04/30/2018] [Accepted: 05/08/2018] [Indexed: 02/06/2023]
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Stanhope KL, Goran MI, Bosy-Westphal A, King JC, Schmidt LA, Schwarz JM, Stice E, Sylvetsky AC, Turnbaugh PJ, Bray GA, Gardner CD, Havel PJ, Malik V, Mason AE, Ravussin E, Rosenbaum M, Welsh JA, Allister-Price C, Sigala DM, Greenwood MRC, Astrup A, Krauss RM. Pathways and mechanisms linking dietary components to cardiometabolic disease: thinking beyond calories. Obes Rev 2018; 19:1205-1235. [PMID: 29761610 PMCID: PMC6530989 DOI: 10.1111/obr.12699] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 03/09/2018] [Accepted: 03/31/2018] [Indexed: 12/11/2022]
Abstract
Calories from any food have the potential to increase risk for obesity and cardiometabolic disease because all calories can directly contribute to positive energy balance and fat gain. However, various dietary components or patterns may promote obesity and cardiometabolic disease by additional mechanisms that are not mediated solely by caloric content. Researchers explored this topic at the 2017 CrossFit Foundation Academic Conference 'Diet and Cardiometabolic Health - Beyond Calories', and this paper summarizes the presentations and follow-up discussions. Regarding the health effects of dietary fat, sugar and non-nutritive sweeteners, it is concluded that food-specific saturated fatty acids and sugar-sweetened beverages promote cardiometabolic diseases by mechanisms that are additional to their contribution of calories to positive energy balance and that aspartame does not promote weight gain. The challenges involved in conducting and interpreting clinical nutritional research, which preclude more extensive conclusions, are detailed. Emerging research is presented exploring the possibility that responses to certain dietary components/patterns are influenced by the metabolic status, developmental period or genotype of the individual; by the responsiveness of brain regions associated with reward to food cues; or by the microbiome. More research regarding these potential 'beyond calories' mechanisms may lead to new strategies for attenuating the obesity crisis.
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Affiliation(s)
- K L Stanhope
- Department of Molecular Biosciences, School of Veterinary Medicine, University of California, Davis, CA, USA
| | - M I Goran
- Department of Preventive Medicine, Diabetes and Obesity Research Institute, University of Southern California, Los Angeles, CA, USA
| | - A Bosy-Westphal
- Institute of Human Nutrition and Food Science, Christian-Albrechts-Universität zu Kiel, Kiel, Germany
| | - J C King
- Children's Hospital Oakland Research Institute, Oakland, CA, USA
| | - L A Schmidt
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, USA
- California Clinical and Translational Science Institute, University of California, San Francisco, San Francisco, CA, USA
- Department of Anthropology, History, and Social Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - J-M Schwarz
- Touro University, Vallejo, CA, USA
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - E Stice
- Oregon Research Institute, Eugene, OR, USA
| | - A C Sylvetsky
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - P J Turnbaugh
- Department of Microbiology and Immunology, G.W. Hooper Research Foundation, University of California, San Francisco, San Francisco, CA, USA
| | - G A Bray
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, USA
| | - C D Gardner
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - P J Havel
- Department of Molecular Biosciences, School of Veterinary Medicine, University of California, Davis, CA, USA
- Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - V Malik
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - A E Mason
- Department of Psychiatry, Osher Center for Integrative Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - E Ravussin
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, USA
| | - M Rosenbaum
- Division of Molecular Genetics, Department of Pediatrics, Columbia University, New York, NY, USA
| | - J A Welsh
- Department of Pediatrics, Emory University School of Medicine, Wellness Department, Children's Healthcare of Atlanta, Nutrition and Health Sciences Doctoral Program, Laney Graduate School, Emory University, Atlanta, GA, USA
| | - C Allister-Price
- Department of Molecular Biosciences, School of Veterinary Medicine, University of California, Davis, CA, USA
| | - D M Sigala
- Department of Molecular Biosciences, School of Veterinary Medicine, University of California, Davis, CA, USA
| | - M R C Greenwood
- Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - A Astrup
- Department of Nutrition, Exercise, and Sports, Faculty of Sciences, University of Copenhagen, Copenhagen, Denmark
| | - R M Krauss
- Children's Hospital Oakland Research Institute, Oakland, CA, USA
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154
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Mechanisms of NAFLD development and therapeutic strategies. Nat Med 2018; 24:908-922. [PMID: 29967350 DOI: 10.1038/s41591-018-0104-9] [Citation(s) in RCA: 2375] [Impact Index Per Article: 395.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 05/30/2018] [Indexed: 02/07/2023]
Abstract
There has been a rise in the prevalence of nonalcoholic fatty liver disease (NAFLD), paralleling a worldwide increase in diabetes and metabolic syndrome. NAFLD, a continuum of liver abnormalities from nonalcoholic fatty liver (NAFL) to nonalcoholic steatohepatitis (NASH), has a variable course but can lead to cirrhosis and liver cancer. Here we review the pathogenic and clinical features of NAFLD, its major comorbidities, clinical progression and risk of complications and in vitro and animal models of NAFLD enabling refinement of therapeutic targets that can accelerate drug development. We also discuss evolving principles of clinical trial design to evaluate drug efficacy and the emerging targets for drug development that involve either single agents or combination therapies intended to arrest or reverse disease progression.
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155
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Future of Treatment for Nonalcoholic Steatohepatitis: Can the Use of Safe, Evidence-Based, Clinically Proven Supplements Provide the Answer to the Unmet Need? Dig Dis Sci 2018; 63:1726-1736. [PMID: 29679298 DOI: 10.1007/s10620-018-5080-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 04/16/2018] [Indexed: 02/07/2023]
Abstract
The epidemic of nonalcoholic fatty liver disease (NAFLD) has created a real and unmet therapeutic need. The long regulatory pathway and the focus on selected subsets of patients with established and advanced disease are some of the current obstacles to providing effective treatment for the majority of NAFLD patients. The complexity of the disease pathogenesis, which involves multiple mechanisms, requires targeting of more than one pathway or a combination-based therapy. Although the drugs being developed may prevent progression to cirrhosis or may decrease negative liver outcomes, their effects on cardiometabolic health and cancer prevention remain unknown. Providing expensive compounds to a large proportion of the population for long-term use would place an economic burden on health care providers. Thus, there is a missed opportunity for early intervention in the course of the disease, by providing agents that improve cardiometabolic status and the progression of fatty liver toward steatohepatitis. Several natural supplements have the potential to meet these needs. This review discusses some of the major obstacles to drug development for NASH treatment. Milestones in bringing evidenced-based, scientifically proven, patent-protected, clinically tested, safe compounds to patients with NAFLD or NASH within a relatively short period of time are presented. The regulatory, intellectual property, manufacturing, and clinical development steps, along with applicable timelines, are discussed. These compounds may provide a possible solution to the challenges associated with the treatment of the majority of patients.
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Abstract
PURPOSE OF REVIEW To review recent evidence for the role of dietary carbohydrate in de novo lipogenesis (DNL) and nonalcoholic fatty liver disease (NAFLD). RECENT FINDINGS A large body of evidence suggests that increased hepatic DNL is a significant pathway contributing to the development of NAFLD. Dietary carbohydrates, in particular, fructose, have been shown to stimulate DNL and increase liver fat, although it is debated whether this is due to excess energy or fructose per se. Recent dietary intervention studies conducted in energy balance show that high-fructose diets increase DNL and liver fat, whereas fructose restriction decreases DNL and liver fat. SUMMARY The association of high-carbohydrate and high-sugar diets with NAFLD may in part be explained by the effect of sugar on increasing hepatic DNL.
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Affiliation(s)
- Sally Chiu
- College of Osteopathic Medicine, Touro University California, Vallejo
- Children's Hospital Oakland Research Institute, Oakland
| | - Kathleen Mulligan
- College of Osteopathic Medicine, Touro University California, Vallejo
- Department of Medicine, University of California, San Francisco
- Division of Endocrinology, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Jean-Marc Schwarz
- College of Osteopathic Medicine, Touro University California, Vallejo
- Department of Medicine, University of California, San Francisco
- Division of Endocrinology, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
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157
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Ikeda K, Sato T, Nakayama T, Tanaka D, Nagashima K, Mano F, Joo E, Fujimoto S, Takahashi Y, Kosugi S, Sekine A, Tabara Y, Matsuda F, Inagaki N. Dietary habits associated with reduced insulin resistance: The Nagahama study. Diabetes Res Clin Pract 2018; 141:26-34. [PMID: 29679632 DOI: 10.1016/j.diabres.2018.04.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 03/08/2018] [Accepted: 04/04/2018] [Indexed: 12/21/2022]
Abstract
AIMS To investigate the association between insulin resistance assessed by a homeostasis model and dietary habits. METHODS Cross-sectional analysis using a community-based cohort, the Nagahama Prospective Cohort for Comprehensive Human Bioscience. Multiple linear regression analysis was performed with log HOMA-IR or log HOMA-β as the dependent variable and 20 dietary habits, tobacco smoking, medical history, family medical history of diabetes, age and BMI as the simultaneous independent variables in each sex separately. RESULTS Females (n = 2956) eating fish dishes every day had a HOMA-IR 0.90 times that of the reference group (P = 0.043). Females eating miso-soup every day had a HOMA-IR 0.95 times that of the reference group (P = 0.038). Males (n = 1371) eating vegetable dishes every day had a HOMA-IR 0.91 times that of the reference group (P = 0.003). Males eating egg dishes 4 to 5 times per week had a HOMA-IR 1.14 times that of the reference group (P = 0.011). Males eating fruits every day had a HOMA-IR 1.13 that of the reference group (P = 0.008). CONCLUSIONS Dietary habits associated with lower insulin resistance were eating fish dishes, miso soup or vegetable dishes every day and eating staple foods for dinner, egg dishes or fruits less frequently.
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Affiliation(s)
- Kaori Ikeda
- Department of Diabetes, Endocrinology and Nutrition, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Tosiya Sato
- Department of Biostatistics, Kyoto University School of Public Health, Kyoto, Japan
| | - Takeo Nakayama
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
| | - Daisuke Tanaka
- Department of Diabetes, Endocrinology and Nutrition, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kazuaki Nagashima
- Department of Diabetes, Endocrinology and Nutrition, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Fumika Mano
- Department of Diabetes, Endocrinology and Nutrition, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Erina Joo
- Department of Diabetes, Endocrinology and Nutrition, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shimpei Fujimoto
- Department of Diabetes, Endocrinology and Nutrition, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yoshimitsu Takahashi
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
| | - Shinji Kosugi
- Department of Medical Ethics and Medical Genetics, Kyoto University School of Public Health, Kyoto, Japan
| | - Akihiro Sekine
- Kyoto University Medical Research Support Center, Kyoto, Japan
| | - Yasuharu Tabara
- Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Fumihiko Matsuda
- Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Nobuya Inagaki
- Department of Diabetes, Endocrinology and Nutrition, Kyoto University Graduate School of Medicine, Kyoto, Japan.
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158
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Sekkarie A, Welsh JA, Vos MB. Carbohydrates and diet patterns in nonalcoholic fatty liver disease in children and adolescents. Curr Opin Clin Nutr Metab Care 2018; 21:283-288. [PMID: 29781841 DOI: 10.1097/mco.0000000000000476] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE OF REVIEW The primary treatment for nonalcoholic fatty liver disease (NAFLD) in children is lifestyle change, including a healthier diet. However, there are no agreed upon expert recommendations for a specific diet in the prevention or treatment of NAFLD. In this study, we review studies published between 2015 and 2017 contributing to further understanding of the role of diet in the development and progression of NAFLD, particularly those addressing sugars and dietary patterns. RECENT FINDINGS Multiple recent studies have expanded on earlier evidence that suggests that high intake of sugars plays a causal role in the development of NAFLD, including several recent experimental studies in adults and children that support a unique effect of fructose consumption on liver fat accumulation. Evidence also points to protective effects of dietary patterns that include but are not limited to minimizing sugar intake, Dietary Approaches to Stop Hypertension (DASH), high protein and the Mediterranean diet. The effect of diet may act through its impact on the microbiome, and may be modified by presence or absence of genetic polymorphisms (nutrigenomics) and several new studies demonstrate this. SUMMARY Diet appears to be a powerful tool in the prevention and treatment of NAFLD. It is imperative that researchers and clinicians continue to hone in on the mechanistic pathways and specific diets to reverse the growing morbidity and mortality of NAFLD.
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Affiliation(s)
- Ahlia Sekkarie
- Department of Pediatrics, School of Medicine, Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, Georgia, USA
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159
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Schwarz JM, Clearfield M, Mulligan K. Conversion of Sugar to Fat: Is Hepatic de Novo Lipogenesis Leading to Metabolic Syndrome and Associated Chronic Diseases? J Osteopath Med 2018; 117:520-527. [PMID: 28759094 DOI: 10.7556/jaoa.2017.102] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Epidemiologic studies suggest a link between excess sugar consumption and obesity, fatty liver disease, metabolic syndrome, and type 2 diabetes mellitus. One important pathway that may link these metabolic diseases to sugar consumption is hepatic conversion of sugar to fat, a process known as de novo lipogenesis (DNL). Mechanistic studies have shown that diets high in simple sugars increase both DNL and liver fat. Importantly, removal of sugar from diets of children with obesity for only 9 days consistently reduced DNL and liver fat and improved glucose and lipid metabolism. Although the sugar and beverage industries continue to question the scientific evidence linking high-sugar diets to metabolic diseases, major health organizations now make evidence-based recommendations to limit consumption of simple sugars to no more than 5% to 10% of daily intake. Clear recommendation about moderating sugar intake to patients may be an important nonpharmacologic tool to include in clinical practice.
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160
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Ludwig DS, Hu FB, Tappy L, Brand-Miller J. Dietary carbohydrates: role of quality and quantity in chronic disease. BMJ 2018; 361:k2340. [PMID: 29898880 PMCID: PMC5996878 DOI: 10.1136/bmj.k2340] [Citation(s) in RCA: 156] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- David S Ludwig
- New Balance Foundation Obesity Prevention Center, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
- Department of Nutrition, Harvard T H Chan School of Public Health, Boston, USA
| | - Frank B Hu
- Department of Nutrition, Harvard T H Chan School of Public Health, Boston, USA
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston
| | - Luc Tappy
- Department of Physiology, University of Lausanne, Lausanne, Switzerland
| | - Jennie Brand-Miller
- Charles Perkins Centre, School of Life and Environmental Sciences, University of Sydney, Sydney, Australia
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161
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Page MM, Johnson JD. Mild Suppression of Hyperinsulinemia to Treat Obesity and Insulin Resistance. Trends Endocrinol Metab 2018; 29:389-399. [PMID: 29665988 DOI: 10.1016/j.tem.2018.03.018] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 03/23/2018] [Accepted: 03/27/2018] [Indexed: 12/14/2022]
Abstract
Insulin plays roles in lipid uptake, lipolysis, and lipogenesis, in addition to controlling blood glucose levels. Excessive circulating insulin is associated with adipose tissue expansion and obesity, yet a causal role for hyperinsulinemia in the development of mammalian obesity has proven controversial, with many researchers suggesting it as a consequence of insulin resistance. Recently, evidence that specifically reducing hyperinsulinemia can prevent and reverse obesity in animal models has been presented. Our experiments, and others in this field, question the current dogma that hyperinsulinemia is a response to obesity and/or insulin resistance. In this review, we discuss preclinical evidence in the context of the broader literature and speculate on the possibility of clinical translation of alternative approaches for treating obesity.
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Affiliation(s)
- Melissa M Page
- Life Sciences Institute Diabetes Research Group and the Department of Cellular and Physiological Sciences, University of British Columbia, Vancouver, BC, Canada; Louvain Institute of Biomolecular Science and Technology, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | - James D Johnson
- Life Sciences Institute Diabetes Research Group and the Department of Cellular and Physiological Sciences, University of British Columbia, Vancouver, BC, Canada. https://twitter.com/JimJohnsonSci
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Malhotra A, Schofield G, Lustig RH. The science against sugar, alone, is insufficient in tackling the obesity and type 2 diabetes crises – We must also overcome opposition from vested interests. JOURNAL OF INSULIN RESISTANCE 2018. [DOI: 10.4102/jir.v3i1.39] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
No abstract available.
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163
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Tappy L. Fructose metabolism and noncommunicable diseases: recent findings and new research perspectives. Curr Opin Clin Nutr Metab Care 2018; 21:214-222. [PMID: 29406418 DOI: 10.1097/mco.0000000000000460] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
PURPOSE OF REVIEW There is increasing concern that dietary fructose may contribute to the development of noncommunicable diseases. This review identifies major new findings related to fructose's physiological or adverse effects. RECENT FINDINGS Fructose is mainly processed in splanchnic organs (gut, liver, kidneys) to glucose, lactate, and fatty acids, which can then be oxidized in extrasplanchnic organs and tissues. There is growing evidence that splanchnic lactate production, linked to extrasplanchnic lactate metabolism, represents a major fructose disposal pathway during and after exercise. Chronic excess fructose intake can be directly responsible for an increase in intrahepatic fat concentration and for the development of hepatic, but not muscle insulin resistance. Although it has long been thought that fructose was exclusively metabolized in splanchnic organs, several recent reports provide indirect that some fructose may also be metabolized in extrasplanchnic cells, such as adipocytes, muscle, or brain cells; the quantity of fructose directly metabolized in extrasplanchnic cells, and its physiological consequences, remain however unknown. There is also growing evidence that endogenous fructose production from glucose occurs in humans and may have important physiological functions, but may also be associated with adverse health effects. SUMMARY Fructose is a physiological nutrient which, when consumed in excess, may have adverse metabolic effects, mainly in the liver (hepatic insulin resistance and fat storage). There is also concern that exogenous or endogenously produced fructose may be directly metabolized in extrasplanchnic cells in which it may exert adverse metabolic effects.
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Affiliation(s)
- Luc Tappy
- Physiology Department, Faculty of Biology and Medicine, University of Lausanne, Lausanne
- Metabolic Center, Hôpital Intercantonal de la Broye, Estavayer-le-lac, Switzerland
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165
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Jensen T, Abdelmalek MF, Sullivan S, Nadeau KJ, Green M, Roncal C, Nakagawa T, Kuwabara M, Sato Y, Kang DH, Tolan DR, Sanchez-Lozada LG, Rosen HR, Lanaspa MA, Diehl AM, Johnson RJ. Fructose and sugar: A major mediator of non-alcoholic fatty liver disease. J Hepatol 2018; 68:1063-1075. [PMID: 29408694 PMCID: PMC5893377 DOI: 10.1016/j.jhep.2018.01.019] [Citation(s) in RCA: 536] [Impact Index Per Article: 89.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 01/18/2018] [Accepted: 01/22/2018] [Indexed: 12/11/2022]
Abstract
Non-alcoholic fatty liver disease (NAFLD) is the hepatic manifestation of metabolic syndrome; its rising prevalence parallels the rise in obesity and diabetes. Historically thought to result from overnutrition and a sedentary lifestyle, recent evidence suggests that diets high in sugar (from sucrose and/or high-fructose corn syrup [HFCS]) not only increase the risk of NAFLD, but also non-alcoholic steatohepatitis (NASH). Herein, we review the experimental and clinical evidence that fructose precipitates fat accumulation in the liver, due to both increased lipogenesis and impaired fat oxidation. Recent evidence suggests that the predisposition to fatty liver is linked to the metabolism of fructose by fructokinase C, which results in ATP consumption, nucleotide turnover and uric acid generation that mediate fat accumulation. Alterations to gut permeability, the microbiome, and associated endotoxemia contribute to the risk of NAFLD and NASH. Early clinical studies suggest that reducing sugary beverages and total fructose intake, especially from added sugars, may have a significant benefit on reducing hepatic fat accumulation. We suggest larger, more definitive trials to determine if lowering sugar/HFCS intake, and/or blocking uric acid generation, may help reduce NAFLD and its downstream complications of cirrhosis and chronic liver disease.
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Affiliation(s)
- Thomas Jensen
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.
| | | | - Shelby Sullivan
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Kristen J Nadeau
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Melanie Green
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Carlos Roncal
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Takahiko Nakagawa
- Division of Future Basic Medicine, Nara Medical University, Nara, Japan
| | - Masanari Kuwabara
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Yuka Sato
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Duk-Hee Kang
- Division of Nephrology, Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Dean R Tolan
- Dept of Biology, Boston University, Boston, MA, United States
| | | | - Hugo R Rosen
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Miguel A Lanaspa
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | | | - Richard J Johnson
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
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166
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Kahl KG, Deuschle M, Stubbs B, Schweiger U. Visceral adipose tissue in patients with severe mental illness. Horm Mol Biol Clin Investig 2018; 33:hmbci-2018-0007. [PMID: 29547392 DOI: 10.1515/hmbci-2018-0007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 02/15/2018] [Indexed: 12/25/2022]
Abstract
Background Severe mental illnesses (SMIs), i.e. major depression, schizophrenia and bipolar disorder, are associated with an elevated risk for the development of type-2 diabetes mellitus and cardiovascular disorders. Several factors have been associated with increased cardiometabolic morbidity and mortality in SMI, including lifestyle factors (smoking, inactivity, unhealthy diet), endocrine and immunologic alterations; however, the underlying mechanisms remain to be fully uncovered. It is now well accepted that visceral adipose tissue (VAT) promotes the development of cardiometabolic disorders, at least in part by inflammatory and metabolic functions. Methods This paper reviews studies concerning VAT, with special focus on intra-abdominal and pericardial adipose tissue, in SMI. Results In patients with SMI, several studies have been performed concerning VAT. Most of these studies reported alterations of VAT particularly in patients with major depression and schizophrenia, independent of body weight and body mass index. Some of the studies also reported an increased cardiometabolic risk. Conclusion Patients with SMI are at increased risk of developing cardiometabolic disorders, and display increased amounts of VAT. As studies so far were mainly performed on patients before the onset of cardiometabolic disorders, VAT may serve as a biomarker for patients with SMI to assess cardiometabolic risks beyond established risk scores. Further, interventions aiming at reducing VAT in SMI are highly recommended in long-term multimodal treatment plans.
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Affiliation(s)
- Kai G Kahl
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany, Phone: +49 511-5322495, Fax: +49 511-5328573
| | - Michael Deuschle
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, UK.,Health Service and Population Research Department, Institute of Psychiatry, King's College London, London, UK
| | - Ulrich Schweiger
- Department of Psychiatry and Psychotherapy, University of Lübeck Medical School, Lübeck, Germany
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167
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Tappy L. Fructose-containing caloric sweeteners as a cause of obesity and metabolic disorders. ACTA ACUST UNITED AC 2018. [PMID: 29514881 DOI: 10.1242/jeb.164202] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Compared with other carbohydrates, fructose-containing caloric sweeteners (sucrose, high-fructose corn syrup, pure fructose and fructose-glucose mixtures) are characterized by: a sweet taste generally associated with a positive hedonic tone; specific intestinal fructose transporters, i.e. GLUT5; a two-step fructose metabolism, consisting of the conversion of fructose carbones into ubiquitous energy substrates in splanchnic organs where fructolytic enzymes are expressed, and secondary delivery of these substrates to extrasplanchnic tissues. Fructose is a dispensable nutrient, yet its energy can be stored very efficiently owing to a rapid induction of intestinal fructose transporters and of splanchnic fructolytic and lipogenic enzymes by dietary fructose-containing caloric sweeteners. In addition, compared with fat or other dietary carbohydrates, fructose may be favored as an energy store because it uses different intestinal absorption mechanisms and different inter-organ trafficking pathways. These specific features make fructose an advantageous energy substrate in wild animals, mainly when consumed before periods of scarcity or high energy turnover such as migrations. These properties of fructose storage are also advantageous to humans who are involved in strenuous sport activities. In subjects with low physical activity, however, these same features of fructose metabolism may have the harmful effect of favoring energy overconsumption. Furthermore, a continuous exposure to high fructose intake associated with a low energy turnover leads to a chronic overproduction of intrahepatic trioses-phosphate production, which is secondarily responsible for the development of hepatic insulin resistance, intrahepatic fat accumulation, and increased blood triglyceride concentrations. In the long term, these effects may contribute to the development of metabolic and cardiovascular diseases.
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Affiliation(s)
- Luc Tappy
- Physiology Department, University of Lausanne Faculty of Biology and Medicine, CH-1005 Lausanne, Switzerland
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McGeoch LJ, Patel PR, Mann JP. PNPLA3: A Determinant of Response to Low-Fructose Diet in Nonalcoholic Fatty Liver Disease. Gastroenterology 2018; 154:1207-1208. [PMID: 29452087 DOI: 10.1053/j.gastro.2017.07.054] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Accepted: 07/13/2017] [Indexed: 01/04/2023]
Affiliation(s)
- Luke J McGeoch
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Parth R Patel
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Jake P Mann
- Metabolic Research Laboratories, Institute of Metabolic Science and Department of Paediatrics, University of Cambridge, Cambridge, UK
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169
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Hartmann P, Schnabl B. Risk factors for progression of and treatment options for NAFLD in children. Clin Liver Dis (Hoboken) 2018; 11:11-15. [PMID: 29629177 PMCID: PMC5881937 DOI: 10.1002/cld.685] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
| | - Bernd Schnabl
- MedicineUniversity of California San DiegoLa JollaCA,Department of MedicineVA San Diego Healthcare SystemSan DiegoCA
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170
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Ighbariya A, Weiss R. Insulin Resistance, Prediabetes, Metabolic Syndrome: What Should Every Pediatrician Know? J Clin Res Pediatr Endocrinol 2017; 9:49-57. [PMID: 29280741 PMCID: PMC5790325 DOI: 10.4274/jcrpe.2017.s005] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The Metabolic syndrome describes a clustering of typical cardiovascular risk factors. The syndrome is also known as "Insulin Resistance syndrome" as a substantial part of the pathophysiology is driven by resistance to the metabolic effects of insulin. The major cause of insulin resistance in childhood is a typical lipid partitioning pattern characterized by increased deposition of lipids within insulin responsive tissues, such as the liver and skeletal muscle and within the viscera. This lipid deposition pattern is also associated with infiltration of intra-abdominal tissues with cells of the immune system, inducing systemic, low-grade inflammation typically observed in insulin resistant obese children and adolescents. Several clues derived from a careful history and physical examination, along with a basic laboratory workup, provide clues in regards to risk stratification in obese children.
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Affiliation(s)
- Ahmad Ighbariya
- Ruth Rappaport Children’s Hospital, Clinic of Pediatrics, Haifa, Israel
,* Address for Correspondence: Ruth Rappaport Children’s Hospital, Clinic of Pediatrics, Haifa, Israel E-mail:
| | - Ram Weiss
- Ruth Rappaport Children’s Hospital, Clinic of Pediatrics, Haifa, Israel
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171
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Maffetone PB, Laursen PB. The Prevalence of Overfat Adults and Children in the US. Front Public Health 2017; 5:290. [PMID: 29164096 PMCID: PMC5671970 DOI: 10.3389/fpubh.2017.00290] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 10/19/2017] [Indexed: 12/15/2022] Open
Abstract
The overfat condition is defined as excess body fat sufficient to impair health. The problem exists in most overweight and obese individuals and can also occur in those who are normal-weight and non-obese, often due to excess abdominal fat. Despite previous indications that the prevalence overweight and obesity is leveling, these conditions are currently at their highest levels in US history. Our review estimated the number of overfat Americans at 91% for adults and 69% for children. The primary purpose of this review was to build upon previous estimations of overfat prevalence in developed countries by using new data from the Centers for Disease Control and Prevention to estimate the overfat prevalence in American adults (≥20 years) and children (2-19 years), and to expand the definition of overfat as excess body fat associated with at least one additional risk factor of impaired cardiometabolic or physical health. The secondary goals are to highlight the role of dietary sugar as a primary cause of the overfat pandemic and mention new data showing the increased prevalence of exercise that parallels the rising prevalence of overfat to further emphasize the secondary role exercise may play in fat loss. Current public health guidelines to address the overfat pandemic may require more emphasis on reducing the consumption of refined carbohydrates, including added sugars.
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Affiliation(s)
| | - Paul B. Laursen
- Sports Performance Research Institute New Zealand (SPRINZ), AUT University, Auckland, New Zealand
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172
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173
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Ter Horst KW, Serlie MJ. Fructose Consumption, Lipogenesis, and Non-Alcoholic Fatty Liver Disease. Nutrients 2017; 9:E981. [PMID: 28878197 PMCID: PMC5622741 DOI: 10.3390/nu9090981] [Citation(s) in RCA: 183] [Impact Index Per Article: 26.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 08/25/2017] [Accepted: 09/04/2017] [Indexed: 02/07/2023] Open
Abstract
Increased fructose consumption has been suggested to contribute to non-alcoholic fatty liver disease (NAFLD), dyslipidemia, and insulin resistance, but a causal role of fructose in these metabolic diseases remains debated. Mechanistically, hepatic fructose metabolism yields precursors that can be used for gluconeogenesis and de novo lipogenesis (DNL). Fructose-derived precursors also act as nutritional regulators of the transcription factors, including ChREBP and SREBP1c, that regulate the expression of hepatic gluconeogenesis and DNL genes. In support of these mechanisms, fructose intake increases hepatic gluconeogenesis and DNL and raises plasma glucose and triglyceride levels in humans. However, epidemiological and fructose-intervention studies have had inconclusive results with respect to liver fat, and there is currently no good human evidence that fructose, when consumed in isocaloric amounts, causes more liver fat accumulation than other energy-dense nutrients. In this review, we aim to provide an overview of the seemingly contradicting literature on fructose and NAFLD. We outline fructose physiology, the mechanisms that link fructose to NAFLD, and the available evidence from human studies. From this framework, we conclude that the cellular mechanisms underlying hepatic fructose metabolism will likely reveal novel targets for the treatment of NAFLD, dyslipidemia, and hepatic insulin resistance. Finally, fructose-containing sugars are a major source of excess calories, suggesting that a reduction of their intake has potential for the prevention of NAFLD and other obesity-related diseases.
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Affiliation(s)
- Kasper W Ter Horst
- Department of Endocrinology and Metabolism, Academic Medical Center, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands.
| | - Mireille J Serlie
- Department of Endocrinology and Metabolism, Academic Medical Center, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands.
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174
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Affiliation(s)
- MIRIAM B. VOS
- Emory University School of Medicine and Laney, Graduate School and, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - MICHAEL I. GORAN
- University of Southern California, Keck School of Medicine, Los Angeles, California
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175
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DiNicolantonio JJ, O’Keefe JH, Wilson WL. Sugar addiction: is it real? A narrative review. Br J Sports Med 2017; 52:910-913. [DOI: 10.1136/bjsports-2017-097971] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2017] [Indexed: 11/03/2022]
Abstract
In animal studies, sugar has been found to produce more symptoms than is required to be considered an addictive substance. Animal data has shown significant overlap between the consumption of added sugars and drug-like effects, including bingeing, craving, tolerance, withdrawal, cross-sensitisation, cross-tolerance, cross-dependence, reward and opioid effects. Sugar addiction seems to be dependence to the natural endogenous opioids that get released upon sugar intake. In both animals and humans, the evidence in the literature shows substantial parallels and overlap between drugs of abuse and sugar, from the standpoint of brain neurochemistry as well as behaviour.
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176
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Vreman RA, Goodell AJ, Rodriguez LA, Porco TC, Lustig RH, Kahn JG. Health and economic benefits of reducing sugar intake in the USA, including effects via non-alcoholic fatty liver disease: a microsimulation model. BMJ Open 2017; 7:e013543. [PMID: 28775179 PMCID: PMC5577881 DOI: 10.1136/bmjopen-2016-013543] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 06/20/2017] [Accepted: 06/21/2017] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES Excessive consumption of added sugars in the human diet has been associated with obesity, type 2 diabetes (T2D), coronary heart disease (CHD) and other elements of the metabolic syndrome. Recent studies have shown that non-alcoholic fatty liver disease (NAFLD) is a critical pathway to metabolic syndrome. This model assesses the health and economic benefits of interventions aimed at reducing intake of added sugars. METHODS Using data from US National Health Surveys and current literature, we simulated an open cohort, for the period 2015-2035. We constructed a microsimulation model with Markov chains for NAFLD (including steatosis, non-alcoholic steatohepatitis (NASH), cirrhosis and hepatocellular carcinoma (HCC)), body mass index, T2D and CHD. We assessed reductions in population disease prevalence, disease-attributable disability-adjusted life years (DALYs) and costs, with interventions that reduce added sugars consumption by either 20% or 50%. FINDINGS The model estimated that a 20% reduction in added sugars intake will reduce prevalence of hepatic steatosis, NASH, cirrhosis, HCC, obesity, T2D and CHD. Incidence of T2D and CHD would be expected to decrease by 19.9 (95% CI 12.8 to 27.0) and 9.4 (95% CI 3.1 to 15.8) cases per 100 000 people after 20 years, respectively. A 20% reduction in consumption is also projected to annually avert 0.767 million (M) DALYs (95% CI 0.757M to 0.777M) and a total of US$10.3 billion (B) (95% CI 10.2B to 10.4B) in discounted direct medical costs by 2035. These effects increased proportionally when added sugars intake were reduced by 50%. CONCLUSIONS The decrease in incidence and prevalence of disease is similar to results in other models, but averted costs and DALYs were higher, mainly due to inclusion of NAFLD and CHD. The model suggests that efforts to reduce consumption of added sugars may result in significant public health and economic benefits.
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Affiliation(s)
- Rick A Vreman
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, California, USA
| | - Alex J Goodell
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, California, USA
| | - Luis A Rodriguez
- Department of Epidemiology & Biostatistics, University of California, San Francisco, California, USA
| | - Travis C Porco
- Department of Epidemiology & Biostatistics, University of California, San Francisco, California, USA
- FI Proctor Foundation for Research in Ophthalmology, University of California, San Francisco, California, USA
| | - Robert H Lustig
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, California, USA
- Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
| | - James G Kahn
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, California, USA
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