Diet Diversity and Health Value in Children with Non-alcoholic Fatty Liver Disease and Prader- Willi Syndrome: Association with Cardio-metabolic Risk

Abstract

In Canada, the obesity prevalence rate in children and adolescents has increased significantly during the last four decades resulting in increased incidence of obesity- related health conditions, lower quality of life and greater health care cost. Patients with non-alcoholic fatty liver disease (NAFLD) or Prader-Willi syndrome (PWS) present two different forms of pediatric obesity with cardio-metabolic dysregulation (CMD) being a common feature among them. Few studies have examined whether this is related to poor diet quality (DQ) and lack of diet diversity (DD). DD is the variation of food intake across and within food groups and may be an important contributor to improved DQ if the observed diversity comes from healthy food choices which is the concept of dietary health value (HV). In the present study, DD, HV and overall healthy food diversity of patients with NAFLD (n= 12), PWS (n=8) and controls (n= 16) and their relation to CMD were studied using an adapted version of Healthy Food Diversity Index (HFD-I) and WHO definition for CMD. The results indicated that DD, HV and HFD-I scores were higher in children with higher scores for DQ. It also showed a significantly lower DD and HV in children with NAFLD, CMD, obesity and hyperinsulinemia/ insulin resistance (IR) while PWS patients had the highest scores for HFD-I. It was also displayed that higher scores of DD and HV were associated with higher intake of some relevant nutrients and food groups such as fiber, carbohydrate, protein, vitamin D and E, fruits and vegetables, milk and alternatives and lower intake of MUFA, meat and alternatives. The results of the present study show that increasing DD together with HV may improve the diets in children with NAFLD, CMD and obesity.