Effects of low glycemic index diet on insulin resistance among obese adolescent with non-alcoholic fatty liver disease: a randomized controlled trial

  • Agustini Utari Department of Pediatrics, Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia
  • Muhammad Saifulhaq Maududi Department of Pediatrics, Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia
  • Ninung Rose Diana Kusumawati Department of Pediatrics, Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia
  • Maria Mexitalia Department of Pediatrics, Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia
Keywords: adolescent, glycemic index, HOMA-IR, NAFLD
Abstract viewed: 1110 times
PDF downloaded: 829 times
HTML downloaded: 90 times
EPUB downloaded: 238 times


BACKGROUND Obesity is strongly correlated with insulin resistance (IR) and nonalcoholic fatty liver disease (NAFLD). Some studies suggest that dietary intake with low glycemic index (GI) may prevent IR and reduce the incidences of NAFLD. This study was aimed to determine the effects of low GI diet on IR among obese adolescents with NAFLD.

METHODS This study was a randomized controlled trial conducted in two Junior High Schools in Semarang, Indonesia. The subjects were 12-14 years obese students with NAFLD, which divided into intervention and control groups according to schools using block random allocation. The intervention group received nutrition education and lunch diet (low energy, low GI, and low fat); meanwhile, the control group only received nutrition education for 12 weeks. The biochemical evaluation included fasting blood glucose (FBG) and insulin levels. IR was assessed using homeostatic model assessment-insulin resistance (HOMA-IR).

RESULTS Thirty-two subjects were enrolled in this study, 16 of which were assigned to the intervention group and the other to the control group. After 12 weeks, the energy and carbohydrate intake reduced in the intervention group (p < 0.05), FBG remained unchanged, and HOMA-IR increased (4.9 [3.7]-7.2 [3.5]) compared to the control group (6.4 [4.9]-5.5 [2.8]) (p < 0.05). Meanwhile, within the control group, there were no significant differences in the energy and carbohydrate intake as well as biochemical variables.

CONCLUSIONS Low GI modification diet alone may not reduce IR in the obese
adolescents with NAFLD.


  1. Fan Y, Zhang C, Bu J. Relationship between selected serum metallic elements and obesity in children and adolescent in the U.S. Nutrients. 2017;9(2):104. https://doi.org/10.3390/nu9020104

  2. Schwingshackl L, Hobl LP, Hoffmann G. Effects of low glycaemic index/low glycaemic load vs. high glycaemic index/high glycaemic load diets on overweight/obesity and associated risk factors in children and adolescents: a systematic review and meta-analysis. Nutr J. 2015;14:87. https://doi.org/10.1186/s12937-015-0077-1

  3. Gupta A, Sachdeva A, Mahajan N, Gupta A, Sareen N, Pandey RM, et al. Prevalence of pediatric metabolic syndrome and associated risk factors among school-age children of 10-16 years living in District Shimla, Himachal Pradesh, India. Indian J Endocrinol Metab. 2018;22(3):373-8. https://doi.org/10.4103/ijem.IJEM_251_17

  4. Mohameda AA, Sabry S, Abdallah AM, Elazeem NA, Refaey D, Algebaly HA, et al. Circulating adipokines in children with nonalcoholic fatty liver disease: possible noninvasive diagnostic markers. Ann Gastroenterol. 2017;30(4):457-63. https://doi.org/10.20524/aog.2017.0148

  5. Mexitalia M, Utari A, Sakundarno M, Yamauchi T, Subagio HW, Soemantri A. Sindroma metabolik pada remaja obesitas. M Med Indones. 2009;43(6):300-5.

  6. Keskin M, Kurtoglu S, Kendirci M, Atabek ME, Yazici C. Homeostasis model assessment is more reliable than the fasting glucose/insulin ratio and quantitative insulin sensitivity check index for assessing insulin resistance among obese children and adolescents. Pediatrics. 2005;115(4):e500-3. https://doi.org/10.1542/peds.2004-1921

  7. Joslowski G, Halim J, Goletzke J, Gow M, Ho M, Louie JC, et al. Dietary glycemic load, insulin load, and weight loss in obese, insulin resistant adolescents: RESIST study. Clin Nutr. 2015;34(1):89-94. https://doi.org/10.1016/j.clnu.2014.01.015

  8. Schwarz JM, Noworolski SM, Erkin-Cakmak A, Korn NJ, Wen MJ, Tai VW, et al. Effects of dietary fructose restriction on liver fat, de novo lipogenesis, and insulin kinetics in children with obesity. Gastroenterology. 2017;153(3):743-52. https://doi.org/10.1053/j.gastro.2017.05.043

  9. Scinta W, Bayes H, Smith N. Insulin resistance and hunger in childhood obesity: a patient and physician's perspective. Adv Ther. 2017;34(10):2386-91. https://doi.org/10.1007/s12325-017-0606-8

  10. Romualdo MC, Nóbrega FJ, Escrivão MA. Insulin resistance in obese children and adolescents. J Pediatr (Rio J). 2014;90(6):600-7. https://doi.org/10.1016/j.jped.2014.03.005

  11. Ma J, Fox CS, Jacques PF, Speliotes EK, Hoffmann U, Smith CE, et al. Sugar-sweetened beverage, diet soda, and fatty liver disease in the Framingham Heart Study cohorts. J Hepatol. 2015;63(2):462-9. https://doi.org/10.1016/j.jhep.2015.03.032

  12. ten Hoor GA, Plasqui G, Schols AM, Kok G. Combating adolescent obesity: an integrated physiological and psychological perspective. Curr Opin Clin Nutr Metab Care. 2014;17(6):521-4. https://doi.org/10.1097/MCO.0000000000000099

  13. Kaya A, Koçyiğit C, Çatli G, Özkan EB, Dündar BN. The relationship between glycemic variability and inflammatory markers in obese children with insulin resistance and metabolic syndrome. J Clin Res Pediatr Endocrinol. 2017;9(3):202-7. https://doi.org/10.4274/jcrpe.4031

  14. Mariman EC. An adipobiological model for weight regain after weight loss. Adipobiology. 2011;3:9-15. https://doi.org/10.14748/adipo.v3.265

  15. Ranucci C, Pippi R, Buratta L, Aiello C, Gianfredi V, Piana N, et al. Effects of an intensive lifestyle intervention to treat overweight/obese children and adolescents. Biomed Res Int. 2017;2017:8573725. https://doi.org/10.1155/2017/8573725

  16. Singhal N, Misra A, Shah P, Gulati S, Bhatt S, Sharma S, et al. Impact of intensive school-based nutrition education and lifestyle interventions on insulin resistance, β-cell function, disposition index, and subclinical inflammation among Asian Indian adolescents: a controlled intervention study. Metab Syndr Relat Disord. 2011;9(2):143-50. https://doi.org/10.1089/met.2010.0094

  17. Mager DR, Iñiguez IR, Gilmour S, Yap J. The effect of a low fructose and low glycemic index/load (FRAGILE) dietary intervention on indices of liver function, cardiometabolic risk factors, and body composition in children and adolescents with nonalcoholic fatty liver disease (NAFLD). JPEN J Parenter Enteral Nutr. 2015;39(1):73-84. https://doi.org/10.1177/0148607113501201

  18. Cockcroft EJ, Williams CA, Tomlinson OW, Vlachopoulos D, Jackman SR, Armstrong N, et al. High intensity interval exercise is an effective alternative to moderate intensity exercise for improving glucose tolerance and insulin sensitivity in adolescent boys. J Sci Med Sport. 2015;18(6):720-4. https://doi.org/10.1016/j.jsams.2014.10.001

  19. Botero D, Ebbeling CB, Blumberg JB, Ribaya-Mercado JD, Creager MA, Swain JF, et al. Acute effects of dietary glycemic index on antioxidant capacity in a nutrient-controlled feeding study. Obesity (Silver Spring). 2009;17(9):1664-70. https://doi.org/10.1038/oby.2009.203

  20. Solomon TP, Haus JM, Kelly KR, Cook MD, Riccardi M, Rocco M, et al. Randomized trial on the effects of a 7-d low-glycemic diet and exercise intervention on insulin resistance in older obese humans1-3. Am J Clin Nutr. 2009;90(5):1222-9. https://doi.org/10.3945/ajcn.2009.28293

  21. Marson EC, Delevatti RS, Prado AK, Netto N, Kruel LF. Effects of aerobic, resistance, and combined exercise training on insulin resistance markers in overweight or obese children and adolescents: A systematic review and meta-analysis. Prev Med. 2016;93:211-8. https://doi.org/10.1016/j.ypmed.2016.10.020

  22. Ballerini MG, Bergadá I, Rodríguez ME, Keselman A, Bengolea VS, Pipman V, et al. Insulin level and insulin sensitivity indices among healthy children and adolescents. Arch Argent Pediatr. 2016;114(4):329-36. https://doi.org/10.5546/aap.2016.eng.329

How to Cite
Utari A, Maududi MS, Kusumawati NRD, Mexitalia M. Effects of low glycemic index diet on insulin resistance among obese adolescent with non-alcoholic fatty liver disease: a randomized controlled trial. Med J Indones [Internet]. 2019Aug.9 [cited 2022Dec.8];28(2):123-8. Available from: http://mji.ui.ac.id/journal/index.php/mji/article/view/2496
Clinical Research