BetaineA Prospective, Randomized, Open Label Trial of Two Doses of Oral Betaine

Inclusion Criteria:

Inclusion Criteria for all patients:

1. Age 18-75 years
2. A clinical diagnosis of non-alcoholic fatty liver disease.
3. Alanine aminotransferase (ALT) levels ≥60 IU/mL
4. Laboratory tests as defined below:

• Platelets > 100,000/dL
• Total bilirubin < 2 mg/dL
• Creatinine < 1.6 mg/dL

• Inclusion Criteria for Group 1: diabetic patients

1. At least one of the following:

• Fasting blood sugar ≥ 126mg/dL
• Hemoglobin A1c (HgA1c) of > 6.5%
• 2-hour plasma glucose level of > 200mg/dL during a glucose tolerance test
• Receiving treatment with insulin sensitizing drugs (metformin) or sulfonylureas (glipizide, etc.) 3. Inclusion Criteria for Group 2: Non-diabetic patients with insulin resistance (must have both)
• Fasting blood glucose of 100-125 mg/dL and
• Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) score >3.0

Exclusion Criteria:

1. Evidence of liver disease other than non-alcoholic fatty liver disease or non-alcoholic steatohepatitis
2. Alcohol consumption of more than 12g/d (1 drink) for females or more than 24g/day (2 drinks) for males, for 3 months during the past year
3. Active substance abuse within the past year
4. Prior or ongoing use of injectable insulin
5. Use of oral corticosteroids within the prior 30 days
6. Hospitalization within the past 14 days
7. Known HIV infection
8. HgA1c >10%
9. Known heart failure of New York Heart Association class 2, 3, or 4
10. Any condition, which in the opinion of the investigator, would impede compliance or hinder the completion of the study
11. History of allergic reactions attributed to compounds of similar chemical or biologic composition to betaine
12. Current use of betaine or S-adenosylmethionine supplements, or refusal to abstain from their use during the study
13. Known cystathionine beta-synthase (CBS) deficiency.
14. Pregnancy or refusal to use birth control measures or breast feeding