Dietary advice for overweight children

- with non-alcoholic fatty liver disease

Weight-challenged children and teenagers have grown to become a global health threat, and the problem became even worse during the corona pandemic. Overweight is linked to a number of health problems, including non-alcoholic fatty liver disease that sets the stage for type 2 diabetes and other serious ailments. In a new review article that is published in Nutrients, researchers look closer at how a carbohydrate-restricted diet or the traditional Mediterranean diet can help to counteract the development of overweight and non-alcoholic fatty liver disease. Also, supplementation with vitamin E, vitamin D, fish oil, and probiotics can block the development of non-alcoholic fatty liver via different metabolic parameters.

The growing rate of overweight among adults, teenagers, and children in the world is alarming. An estimated 41 million children under the age of five years are overweight, while 340 million children and teenagers between five and 19 years of age are overweight. According to the Centers for Disease Control and Prevention (CDC), the BMI of children between two and 19 years of age has increased during the corona pandemic as a result of extensive lockdowns and other restrictive measures.
Because overweight is linked to different metabolic disturbances, losing weight as an adult becomes increasingly difficult. Overweight is known to cause problems like non-alcoholic fatty liver disease (NAFLD) where fat accumulates in the liver (steatosis). This primarily happens if the liver is flooded by carbohydrates, which turns it into a virtual fat factory. Non-alcoholic fatty liver disease is also linked to insulin resistance, disrupted cytokine signaling, chronic inflammation, and imbalances in the gut flora. Moreover, NAFLD is closely related to type 2 diabetes. Many people with NAFLD also develop a type of liver inflammation called non-alcoholic steatohepatitis (NASH) that forms scar tissue (fibrosis) in the liver and liver failure, in worst case.
The aim of the new study was to look closer at the relation between diet, overweight, and non-alcoholic fatty liver disease in children and teenagers and to see if certain supplements can help prevent and manage overweight and accompanying metabolic disturbances.

Healthier diets and exercise are the first vital steps to fight overweight

By trawling the scientific database PubMed, the scientists gathered a number of clinical studies from the period 2012-2022 that looked at overweight children and youngsters under 18 years of age, who had non-alcoholic fatty liver disease. It was apparent that healthy eating habits and exercise are a vital first step in the prevention and treatment of overweight and NAFLD. Also, a carbohydrate-restricted diet with many healthy fats appears to have a positive impact. The same is the case with the traditional Mediterranean diet that is based on vegetables, herbs and olive oil, fruit, nuts, fish, shellfish, and lean meat. The Mediterranean diet is able to stabilize blood sugar levels and can also fight inflammation because of its properly balanced content of polyunsaturated fatty acids combined with different antioxidants and fibers. Apparently, supplementation with vitamin E, vitamin D, omega-3 fatty acids, and lactic acid bacteria can also help prevent the development of non-alcoholic fatty liver disease.

Vitamin E and other antioxidants counteract oxidative stress

Oxidative stress is a critical factor in the development of NAFLD and NASH. Oxidative stress is when the body is attacked by free radicals that cause damage to cells in the liver and other organs. Our only source of protection against free radicals is the presence of different antioxidants that are able to neutralize them. Several studies have shown that vitamin E supplementation of overweight children with NAFLD has a positive effect on BMI, blood sugar levels, insulin, and cholesterol balance, especially when combined with physical activity.

Vitamin D in large doses has the best effect on different parameters

Not only is vitamin D important for bone health but also for a number of metabolic processes in the body such as regulating levels of blood sugar and cholesterol and controlling inflammation. The authors behind the review article refer to a placebo-controlled study where overweight children with NAFLD were given 50 micrograms of vitamin D daily or matching placebo for six months. This primarily had a positive effect on levels of LDL cholesterol, insulin, and liver inflammation. Just for the record, health authorities only recommend 5-10 micrograms of vitamin D for children and youngsters, but it apparently takes more to obtain an optimal effect. What is also worth taking into consideration is that many children and youngsters avoid sun exposure, use too much sun factor cream, or fail to get the recommended amount of vitamin D from supplements, which contributes to the widespread vitamin D deficiency problem.

Fish oil regulates the cholesterol balance, inflammation, and blood sugar levels

Fish oil contains the two omega-3 fatty acids, EPA and DHA, that have a number of different physiological functions. It is important to balance ones intake of omega-3 and omega-6 fatty acids, which we primarily get from plant oils. Unfortunately, Western diets contains far too much refined omega-6 and too little omega-3, which increases the risk of chronic inflammation and other metabolic disturbances.
The authors refer to various placebo-controlled studies were overweight children and youngsters with non-alcoholic fatty liver disease have been supplemented with 500 mg of fish oil daily. This had a positive influence on cholesterol balance, inflammation, blood sugar levels, and insulin. Also, it is important for children and youngsters to get the recommended intake of fish or to take a fish oil supplement if they don’t like fish or simply don’t get enough.

Lactic acid bacteria and other types of probiotics

Probiotics are microorganisms that are beneficial for our digestion, gut flora, and health in general. The dominating bacteria in our intestinal microflora are different lactic acid bacteria and bifodo bacteria that work by maintaining optimal pH values in our intestinal lining, displacing harmful bacteria and fungi, and counteracting local inflammation. Probiotics also appear to have a positive effect on non-alcoholic fatty liver disease.

References

Chiara Spiezia et al. Nutritional Approaches in Children with Overweight or Obesity and Hepatic Steatosis. Nutrients 2023