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Results of animal experiments suggest that consumption of refined carbohydrates (e.g. fructose) can result in small intestinal bacterial overgrowth and increased intestinal permeability, thereby contributing to the development of nonalcoholic fatty liver disease (NAFLD). Furthermore, increased plasminogen activator inhibitor (PAl)-1 has been linked to liver damage of various etiologies (e.g. alcohol, endotoxin, nonalcoholic). The aim of the present pilot study was to compare dietary factors, endotoxin, and PAl-1 concentrations between NAFLD patients and controls. We assessed the dietary intake of 12 patients with NAFLD and 6 control subjects. Plasma endotoxin and PAl-1 concentrations as well as hepatic expression of PAl-1 and toll-like receptor (TLR) 4 mRNA were determined. Despite similar total energy, fat, protein, and carbohydrate intakes, patients with NAFLD consumed significantly more fructose than controls. Endotoxin and PAl-1 plasma concentrations as well as hepatic TLR4 and PAl-1 mRNA expression of NAFLD patients were significantly higher than in contrors. The plasma PAl-1 concentration was positively correlated with the plasma endotoxin concentration (Spearman r = 0.83; P < 0.005) and hepatic TLR4 mRNA expression (Spearman r = 0.54; P < 0.05). Hepatic mRNA expression of PAl-1 was positively associated with dietary intakes of carbohydrates (Spearman r = 0.67; P < 0.01), glucose (Spearman r = 0.58; P < 0.01 ), fructose (Spearman r = 0.58; P < 0.01), and sucrose (Spearman r = 0.70; P < 0.01). In conclusion, our results suggest that dietary fructose intake, increased intestinal translocation of bacterial endotoxin, and PAl-1 may contribute to the development of NAFLD in humans.

Non-insulin-dependent diabetes mellitus should become less prevalent in a more informed, modern age than ever before. Contrary to the belief that one should return to the lifestyle of our ancestors, efforts should be made to educate about fat avoidance and sugar avoidance as well as the benefits of exercise. Comparisons of lower-income barrio residents and more affluent suburbians indicate less weight problems and more health attitudes in the latter group.

Eating processed grains and little fiber appears to be a risk factor for non-insulin-dependent, or adult-onset, diabetes mellitus (NIDDM). Researchers followed for 6 years 65,173 women who provided detailed dietary information. During the study, 915 women developed NIDDM. Eating foods with a high glycemic index appeared to be a risk factor for NIDDM. These foods stimulate excessive production of insulin and typically include processed grains. A low-fiber diet was also associated with the development of NIDDM, specifically a diet low in cereal fiber., Objective.--To examine prospectively the relationship between glycemic diets, low fiber intake, and risk of non-insulin-dependent diabetes mellitus. Design.--Cohort study. Setting.--In 1986, a total of 65173 US women 40 to 65 years of age and free from diagnosed cardiovascular disease, cancer, and diabetes completed a detailed dietary questionnaire from which we calculated usual intake of total and specific sources of dietary fiber, dietary glycemic index, and glycemic load. Main Outcome Measure.--Non-insulin-dependent diabetes mellitus. Results.--During 6 years of follow-up, 915 incident cases of diabetes were documented. The dietary glycemic index was positively associated with risk of diabetes after adjustment for age, body mass index, smoking, physical activity, family history of diabetes, alcohol and cereal fiber intake, and total energy intake. Comparing the highest with the lowest quintile, the relative risk (RR) of diabetes was 1.37 (95% confidence interval [CI], 1.09-1.71, P trend=.005). The glycemic load (an indicator of a global dietary insulin demand) was also positively associated with diabetes (RR = 1.47; 95% CI, 1.16-1.86, P trend=.003). Cereal fiber intake was inversely associated with risk of diabetes when comparing the extreme quintiles (RR = 0.72, 95% CI, 0.58-0.90, P trend=.001). The combination of a high glycemic load and a low cereal fiber intake further increased the risk of diabetes (RR=2.50, 95% CI, 1.14-5.51) when compared with a low glycemic load and high cereal fiber intake. Conclusions.--Our results support the hypothesis that diets with a high glycemic load and a low cereal fiber content increase risk of diabetes in women. Further, they suggest that grains should be consumed in a minimally refined form to reduce the incidence of diabetes. JAMA. 1997;277:472-477