Diet options for inducing obesity, metabolic syndrome and mild NAFLD/NASH

Diet options for inducing more severe hepatic NAFLD/NASH without obesity or metabolic syndrome

Diets inducing obesity, metabolic syndrome and mild NAFLD/NASH

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Western and Fast Food diets with milkfat and cholesterol

Western or fast food style diets fed to induce NASH with metabolic syndrome contain 40 – 45% kcal from milkfat (a fat source high in palmitate) with added cholesterol (0.15 – 2%) and are high in sucrose (>30%). Dietary palmitate and cholesterol have both previously been associated with the progression from simple steatosis to NASH.

Examples:

• TD.88137 Adjusted Calories Diet (42% from fat)
• TD.96121 21% MF, 1.25% Chol. Diet
• TD.120528 42% Kcal/Fat Diet (Incr. Sucrose, 1.25% Chol.)

 

Research use:

These diets can induce obesity, metabolic syndrome, and simple steatosis within nine weeks of feeding. Increased hepatic inflammation has been observed after 12 weeks of feeding. NASH typically requires longer feeding with fibrosis developing within nine months and late stage fibrosis including hepatic ballooning occurring after 14 – 20 months of feeding. Increasing dietary sucrose (~41%) and cholesterol (~1.25%) accelerates the NASH phenotype with steatosis, inflammation and hepatocyte ballooning observed within 12 weeks. In addition to feeding a high fat diet, providing a glucose/fructose mixture in the drinking water may further promote NASH development.

Select References:

Charlton, M., et al., Fast food diet mouse: novel small animal model of NASH with ballooning, progressive fibrosis, and high physiological fidelity to the human condition. Am J Physiol Gastrointest Liver Physiol, 2011. 301(5): p. G825-34. www.ncbi.nlm.nih.gov/pubmed/21836057

Gores, G., Charlton M, Krishnan A, Viker K, Sanderson S, Cazanave S, McConico A, Masuoko H. Am J Physiol Gastrointest Liver Physiol, 2015. 308: p. G159. ajpgi.physiology.org/content/308/2/G159

Li, Z.Z., et al., Hepatic lipid partitioning and liver damage in nonalcoholic fatty liver disease: role of stearoyl-CoA desaturase. J Biol Chem, 2009. 284(9): p. 5637-44. www.ncbi.nlm.nih.gov/pubmed/19119140

Ioannou, G.N., et al., Hepatic cholesterol crystals and crown-like structures distinguish NASH from simple steatosis. J Lipid Res, 2009. 54(5): p. 1326-34. www.ncbi.nlm.nih.gov/pubmed/23417738

Alkhouri, N., et al., Adipocyte apoptosis, a link between obesity, insulin resistance, and hepatic steatosis. J Biol Chem, 2010. 285(5): p. 3428-38. www.ncbi.nlm.nih.gov/pubmed/19940134 

Dixon, L.J., et al., Caspase-1 as a central regulator of high fat diet-induced non-alcoholic steatohepatitis. PLoS One, 2013. 8(2): p. e56100. www.ncbi.nlm.nih.gov/pubmed/23409132 

DeLeve, L.D., et al., Prevention of hepatic fibrosis in a murine model of metabolic syndrome with nonalcoholic steatohepatitis. Am J Pathol, 2008. 173(4): p. 993-1001. www.ncbi.nlm.nih.gov/pubmed/18772330 

VanSaun, M.N., et al., High fat diet induced hepatic steatosis establishes a permissive microenvironment for colorectal metastases and promotes primary dysplasia in a murine model. Am J Pathol, 2009. 175(1): p. 355-64. www.ncbi.nlm.nih.gov/pubmed/19541928 

Asgharpour, A., et al., A diet-induced animal model of non-alcoholic fatty liver disease and hepatocellular cancer. J Hepatol, 2016. 65(3): p. 579-88. www.ncbi.nlm.nih.gov/pubmed/27261415 

Tetri, L.H., et al., Severe NAFLD with hepatic necroinflammatory changes in mice fed trans fats and a high-fructose corn syrup equivalent. Am J Physiol Gastrointest Liver Physiol, 2008. 295(5): p. G987-95. www.ncbi.nlm.nih.gov/pubmed/18772365 

Tsuchida, T., et al., A simple diet-and chemical-induced murine NASH model with rapid progression of steatohepatitis, fibrosis and liver cancer. Journal of hepatology, 2018. 69(2):385-395. www.ncbi.nlm.nih.gov/pubmed/29572095 

The ALIOS model: western diet with trans-fat

The American Lifestyle-Induced Obesity Syndrome (ALIOS) model involves feeding the “American fast food” diet high in trans-fats and sugar. Dietary trans-fats from hydrogenated vegetable shortening (HVO) are associated with increased insulin resistance and hepatic inflammation in rodent NASH models. In addition to diet, a glucose/fructose solution is added to the drinking water and sedentary behavior promoted by removing the overhead cage feeders in this model.

Examples:

• TD.06303 22% HVO Diet
• TD.120330 22% HVO + 0.2% Cholesterol Diet
• TD.130885 ALIOS with Added Sugar

 

Research use:

The ALIOS model develops obesity with insulin resistance, elevated ALT levels, and steatosis within 16 weeks. Increased inflammation and early development of fibrosis have been observed at 6 months. Severe steatosis with fibrosis and inflammation develops within 12 months of feeding with 50% of the mice reportedly developing hepatic neoplasms. Adding cholesterol (0.2%) to the American Fast Food diet may accelerate NASH phenotype development.

Select References:

Koppe, S.W., et al., Trans fat feeding results in higher serum alanine aminotransferase and increased insulin resistance compared with a standard murine high-fat diet. Am J Physiol Gastrointest Liver Physiol, 2009. 297(2): p. G378-84. www.ncbi.nlm.nih.gov/pubmed/19541924

Tetri, L.H., et al., Severe NAFLD with hepatic necroinflammatory changes in mice fed trans fats and a high-fructose corn syrup equivalent. Am J Physiol Gastrointest Liver Physiol, 2008. 295(5): p. G987-95. www.ncbi.nlm.nih.gov/pubmed/18772365

Mells, J.E., et al., Glp-1 analog, liraglutide, ameliorates hepatic steatosis and cardiac hypertrophy in C57BL/6J mice fed a Western diet. Am J Physiol Gastrointest Liver Physiol, 2012. 302(2): p. G225-35. www.ncbi.nlm.nih.gov/pubmed/22038829

Dowman, J.K, et al., Development of hepatocellular carcinoma in a murine model of nonalcoholic steatohepatitis induced by use of a high-fat/fructose diet and sedentary lifestyle. Am J Pathol, 2014. 184(5):1550-1561. www.ncbi.nlm.nih.gov/pubmed/24650559

Mells, J.E., et al., Saturated fat and cholesterol are critical to inducing murine metabolic syndrome with robust nonalcoholic steatohepatitis. J Nutr Biochem, 2014. 26(3): p. 285-92. www.ncbi.nlm.nih.gov/pubmed/25577467

FPC diet: fructose, palmitate, cholesterol and trans-fat diet

The Fructose, Palmitate, Cholesterol and Trans-Fat (FPC) diet is a recent NASH diet that includes Western and ALIOS model diets to achieve both metabolic and hepatic NASH features within an accelerated time frame. Key features of the FPC diet include 1) a lower Met content than typical rodent diets by decreasing total protein without supplementing sulfur amino acids; 2) choline supplementation is lower than typical but is not considered deficient; 3) high in sucrose (~34% by weight); 4) 1.25% cholesterol; 5) 52% kcal from fat with fat sources including milkfat fat, palmitic acid and hydrogenated vegetable shortening to provide trans-fats. Like the ALIOS model, the FPC model also provides a glucose/fructose solution to the drinking water.

Examples:

• TD.160785 52 kcal/Fat Diet (C16:0, HVO, AMF, Choline/Met)

 

Research use:

Male C57BL/6J mice fed the FPC diet and provided a glucose/fructose drinking solution developed insulin resistance and NAFLD with inflammation, hepatocyte death, and fibrosis within 16 weeks.

Select References:

Wang, X., et al., Hepatocyte TAZ/WWTR1 promotes inflammation and fibrosis in nonalcoholic steatohepatitis. Cell Metab, 2016. 24(6): p. 848-62. www.ncbi.nlm.nih.gov/pubmed/28068223

Zhu, C., et al., Hepatocyte Notch activation induces liver fibrosis in nonalcoholic steatohepatitis. Sci Transl Med, 2018. 10(468). www.ncbi.nlm.nih.gov/pubmed/30463916 

High fat diets

Common diets to induce obesity (DIO) can be fed to induce uncomplicated NAFLD. These high fat diets typically contain 40–60% kcal from fat without supplemented cholesterol or cholate. Simple sugars such as sucrose or fructose can also be supplemented via diet or water to progress the fatty liver phenotype. Diets can be in pellet or powder/dough form depending on the formula. Some models require limited physical activity and in those cases diets can be fed inside the cage. For more information see our Diet Induced Obesity page.

Examples:

• TD.08811 45%kcal Fat Diet (21% MF, 2% SBO)
• TD.06414 Adjusted Calories Diet (60/Fat)

 

Research use:

In susceptible rodent models, high fat diets are commonly used to induce NAFLD with obesity and insulin resistance common metabolic features associated with NASH in humans. However, the degree of NASH pathology (steatosis, inflammation, and fibrosis) is limited or mild and varies depending on the animal model, length of feeding, and dietary components.

Diets to induce severe hepatic NAFLD/NASH without obesity or metabolic

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Atherogenic diets high in fat, cholesterol, and cholate

Originally formulated to induce mild atherosclerosis in wild-type rodents, high fat diets containing added cholesterol (1 – 1.25%) and cholate (0.5% as sodium cholate or cholic acid) have also been useful in inducing NASH. This diet option includes purified “Western” style diets with increased cholesterol and cholate and also hybrid diets. Hybrid diets were originally developed by Beverly Paigen and colleagues by mixing a natural ingredient mouse diet in a 3:1 ratio with a concentrated purified diet (containing 5% cholesterol and 2% sodium cholate) resulting in a diet containing ~15.8% fat, 1.25% cholesterol, and 0.5% sodium cholate. Although a less refined approach, the hybrid diet is associated with increased gallstone formation and liver damage as compared to similar purified diets.

Examples:

• TD.02028 Atherogenic Rodent Diet
• TD.88051 Cocoa Butter Diet and Purina Mouse Chow
• TD.09237 15% AMF Diet (1% Chol, 0.5% NaChol)

 

Research use:

Atherogenic diets are able to induce varied degrees of NASH with increased hepatic inflammation with early fibrosis observed after ten weeks of feeding. However, the metabolic profile typical in human NASH (obesity with insulin resistance) is not recapitulated in this model with animals typically maintaining similar body weights as control fed groups without the development of metabolic syndrome.

Select References:

Nishina, P.M., J. Verstuyft, and B. Paigen, Synthetic low and high fat diets for the study of atherosclerosis in the mouse. J Lipid Res, 1990. 31(5): p. 859-69. www.ncbi.nlm.nih.gov/pubmed/2380634

Kamari, Y., et al., Lack of interleukin-1alpha or interleukin-1beta inhibits transformation of steatosis to steatohepatitis and liver fibrosis in hypercholesterolemic mice. J Hepatol, 2011. 55(5): p. 1086-94. www.ncbi.nlm.nih.gov/pubmed/21354232

Kim, D.G., et al., Non-alcoholic fatty liver disease induces signs of Alzheimer’s disease (AD) in wild-type mice and accelerates pathological signs of AD in an AD model. J Neuroinflammation, 2016. 13: p. 1.
www.ncbi.nlm.nih.gov/pubmed/26728181

Madrigal-Perez, V.M., et al., Preclinical analysis of nonsteroidal anti-inflammatory drug usefulness for the simultaneous prevention of steatohepatitis, atherosclerosis and hyperlipidemia. Int J Clin Exp Med, 2015. 8(12): p. 22477-83. www.ncbi.nlm.nih.gov/pubmed/26885230

Savransky, V., et al., Chronic intermittent hypoxia causes hepatitis in a mouse model of diet-induced fatty liver. Am J Physiol Gastrointest Liver Physiol, 2007. 293(4): p. G871-7. www.ncbi.nlm.nih.gov/pubmed/17690174 

Methionine/choline deficient (MCD) diets

Methionine and choline deficient (MCD) diets are amino acid defined rodent diets deficient in methionine and choline, high in sucrose (>40% by weight) with ~10% corn oil by weight. Methionine and choline deficiency decreases fat oxidation and export of fat from the liver. Dietary sucrose is necessary for hepatic lipid accumulation and oxidation. The polyunsaturated fat in corn oil promotes hepatic lipid oxidation.

Example:

• TD.90262 Methionine/Choline Deficient Diet

 

Control:

• TD.94149 Amino Acid Control Diet

 

Research use:

Steatosis, increased serum alanine aminotransferase (ALT), inflammation, and hepatic fat oxidation has been observed within three weeks of feeding the MCD diet with fibrosis development after six weeks. This dietary model does not produce metabolic syndrome (an aspect of NASH in human models) and progressive weight loss (up to 40%) is associated with the MCD diet feeding.

Select References:

Pickens, M.K., et al., Dietary sucrose is essential to the development of liver injury in the MCD model of steatohepatitis. J Lipid Res, 2009. 50(10):2072-82. www.ncbi.nlm.nih.gov/pubmed/19295183

Li, Z.Z., et al., Hepatic lipid partitioning and liver damage in nonalcoholic fatty liver disease: role of stearoyl-CoA desaturase. J Biol Chem, 2009. 284(9): p. 5637-44. www.ncbi.nlm.nih.gov/pubmed/19119140

Lee, G.S., et al., Polyunsaturated fat in the methionine-choline-deficient diet influences hepatic inflammation but not hepatocellular injury. J Lipid Res, 2007. 48(8): p. 1885-96. www.ncbi.nlm.nih.gov/pubmed/17526933

Vetelainen, R., A. van Vliet, and T.M. van Gulik, Essential pathogenic and metabolic differences in steatosis induced by choline or methione-choline deficient diets in a rat model. J Gastroenterol Hepatol, 2007. 22(9): p. 1526-33. www.ncbi.nlm.nih.gov/pubmed/17716355

Leclercq, I.A., et al., Intrahepatic insulin resistance in a murine model of steatohepatitis: effect of PPARgamma agonist pioglitazone. Lab Invest, 2007. 87(1): p. 56-65. www.ncbi.nlm.nih.gov/pubmed/17075577

Kashireddy, P.R. and M.S. Rao, Sex differences in choline-deficient diet-induced steatohepatitis in mice. Exp Biol Med (Maywood), 2004. 229(2): p. 158-62. www.ncbi.nlm.nih.gov/pubmed/14734794

Dixon, L.J., et al., Caspase-1-mediated regulation of fibrogenesis in diet-induced steatohepatitis. Lab Invest, 2012. 92(5): p. 713-23. www.ncbi.nlm.nih.gov/pubmed/22411067

Emerging NASH models

Dietary models of NAFLD/NASH continue to evolve with the goal of more accurately recapitulating both the metabolic and hepatic symptoms of human disease. Commonly researchers are studying the synergistic effects of various NASH dietary features to accelerate progression of the model and severity of liver disease.

A Teklad nutritionist can work with you to formulate new diets in order to investigate novel dietary models of NAFLD/NASH. Contact a nutritionist at askanutritionist@inotivco.com for a diet consultation.

Control diets

The choice of control diet is dependent on the specific research goal. Many researchers choose to compare their NAFLD/NASH diet-fed animals to animals fed a natural ingredient, grain-based diet (also referred to as standard diet or chow). These diets differ in the source and level of nutrients as well as in the presence of non-nutritive factors (such as phytates or phytoestrogens).

Depending on what your main comparisons are, it may be suitable to have a grain-based diet as your control/reference group. However, making such comparisons limits inferences to dietary patterns versus a specific dietary component. In some cases, such as those studies feeding amino acid defined diets like the MCD model, a matched control diet is recommended given the very different formulations and protein sources of grain-based diets.

When making inferences about specific nutrients within the diet an ingredient matched, low fat control diet may be necessary. There are many options with different levels and types of fat in addition to different types of carbohydrate ranging from sucrose (highly refined and digestible) to corn starch (refined, but more complex) to resistant starch (refined, but not fully digestible).

A very basic purified control diet would be AIN-93M TD.94048 or AIN-93G TD.94045 . AIN-93 diets have a moderate amount of sucrose at ~10% with fat from soybean oil providing a healthy fatty acid profile. Learn more about AIN diet formulas.

Contact a nutritionist for an additional information and control diet recommendations.