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