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12 November, 2003

Once again doctors are doing opposite of what's best for the patient - good for business, though.

Zoe Lenska


Low-Fat, High-Carb Diet for Morbidly Obese

By Peggy Peck

BOSTON (Reuters Health) Oct 27 - The high-carbohydrate, low-fat diet often recommended for morbidly obese patients with fatty liver disease is associated with increased liver inflammation, physicians at Johns Hopkins Medical Institutions report.

Conversely, high fat diets were associated with a lower risk for inflammation, according to study results presented at the 54th Annual Meeting of the American Association for the Study of Liver Diseases.

Dr. Jeanne M. Clark, assistant professor of medicine, said in an interview that the results are hypothesis-generating and point out the need for a prospective study. "But meanwhile, once again we are faced with results that suggest we need to be very cautious in our dietary recommendations," she said.

It appears, Dr. Clark said, that recommending low-fat diet in morbidly obese patients could "worsen non-alcoholic fatty liver disease."

The findings come from a study of intra-operative liver biopsies obtained from 74 consecutive morbid obesity patients undergoing bariatric surgery. All patients underwent a pre-operative dietary evaluation and a 24-hour food recall questionnaire. The biopsy samples were reviewed and scored for steatosis, inflammation and fibrosis by a pathologist blinded to clinical and dietary information.

Using the diet recall data, the Baltimore team estimated the total calories as well as carbohydrate, protein and total fat of their diets. The patients were divided into low, medium or high categories for total fat, carbohydrates and protein consumption.

The mean age of the patients was 44 years, 86% were white and 88% were female. The median BMI was 55 kg/m (range 41-97). A total of 89% of patients had at least some degree of steatosis, with 30% having moderate to severe steatosis involving more than 33% of hepatocytes. Sixty-nine percent of the patients had inflammation, and 41% had fibrosis.

Compared with patients with the lowest carbohydrate intake, a high- carbohydrate diet was associated with an odds ratio of 7.0 (p = 0.02) for liver inflammation. A high fat diet appeared to be protective, with those in the highest fat intake group having an OR of 0.17 (p = 0.009).

Dr. Clark noted that the study appears to support diets such as the Atkins Diet, but she declined to make a recommendation.


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