Super HEROES: Searching How the Extract Rebaudioside Occludes Excess Steatosis

Rationale: Current treatment strategies for Nonalcoholic fatty liver disease, NAFLD, have focused on lifestyle management through a combination of diet and exercise but there are no recommendations for dietary changes that have been proven superior to others. Preliminary data showing an improvement in liver enzymes and fibrosis in mice has demonstrated a novel use of rebaudioside, the non-caloric sweetener (NCS) Stevia leaf's extract, potentially identifying this NCS as a therapeutic intervention where currently there are no targeted treatments.

Intervention: All participants will receive standard of care for diet and nutrition. Additionally, participants will be randomized to one of four 8-week liquid diet interventions:

• Standard of Care
• Water Delivery
• Water with Rebaudioside (Stevia Natural Sweetener)

Objectives and Purpose: To determine whether rebaudioside consumption can be used as a treatment for adolescents with NAFLD by demonstrating a decrease in ALT levels.

Inclusion criteria

• Age: 10-18 years
• ALT > 45 IU/L (twice the normal amount)
• BMI >85%
• Fat >5% and kPa> 2.7

Exclusion criteria

• Physician diagnosis of a major medical illness including, but not limited to, chronic liver disease, immunodeficiency disorder, hypothalamic obesity, or a genetic cause of obesity.
• Familial hyperlipidemia
• Positive hepatitis lab
• Antibiotics within 1 month of beginning the study
• Physical, mental, or cognitive issues preventing participation
• Pregnancy
• Smoking or drinking