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The diabetes epidemic, new studies show, is destined to have another co-factor that might prove to be even more deadly than the disease itself: liver disease. It appears "high glycemic" foods such as white breads, white rice, most processed grains and sugary cereals lead to fatty liver, a condition that results in liver failure and death.

The work of Dr David Ludwig, director of the Optimal Weight for Life program at Children's Hospital Boston, and colleagues, was published in the September issue of the journal "Obesity". Fatty liver is increasing in line with rising rates of obesity among Americans. The researchers hope to confirm their findings in a newly launched clinical trial with overweight children and to show that the trend can be reversed through changes in diet.

Ludwig said that fatty liver is becoming especially common among children. Many adult cases can be caused by alcoholism. This is not so in children, where between 1 in 4 and 1 in 2 overweight American children are thought to be affected by non-alcoholic fatty liver disease (NAFLD). Ludwig said the French delicacy "pâté de foie gras" was made by feeding ducks and geese on a diet rich in high GI grains.

Ludwig explained that sugar released from high GI food ramps up insulin production, which tells the body to make and store fat. This is a burden to the liver because the pancreas produces the insulin and sends it straight to the liver, resulting in liver insulin levels way above the rest of the body.

Low GI foods include most vegetables, fruits, beans and unprocessed grains. The starch in them is digested slowly and therefore eating them raises blood sugar slowly. This is also called slowly absorbed carbohydrate (SAC).

Ludwig and colleagues carried out the study using two groups of laboratory mice. One group of mice were fed a high GI diet based on a type of cornstarch that is digested quickly, and the other a low GI diet, based on a more slowly digested cornstarch.

Fatty liver usually has no symptoms, but it raises the risk of liver inflammation, which can lead to hepatitis, which is sometimes fatal.