Effect of vitamin E on aminotransferase levels and insulin resistance in children with non-alcoholic fatty liver disease.
BACKGROUND
Few data are available on the effect of antioxidants in paediatric non-alcoholic fatty liver disease (NAFLD).


OBJECTIVE
To compare the effect of a nutritional programme alone or combined with alpha-tocopherol and ascorbic acid on alanine aminotransferase (ALT) levels, and insulin resistance (IR) in biopsy-proven NAFLD children.


METHODS
IN a 12-month double-blind placebo study, 90 patients were prescribed a balanced calorie diet (25-30 cal/kg/d), physical exercise, and placebo (group A) or alpha-tocopherol 600 IU/day plus ascorbic acid 500 mg/day (group B). IR was estimated by the homeostasis model assessment (HOMA-IR).


RESULTS
At month 12, ALT (32.67 +/- 8.09 vs. 32.18 +/- 11.39 IU/L; P = NS), HOMA-IR (1.52 +/- 0.66 vs. 1.84 +/- 0.95 IU/L; P = NS), and weight loss (32% vs. 35% of excessive body weight; P = NS) did not differ between the two arms. Among subjects who lost >or=20% of their excessive weight, ALT and body weight percentage changes were significantly related (r(o) = 0.260; P = 0.03). In subjects, who lost more than 1.0 kg, HOMA-IR significantly decreased (2.20 +/- 0.21 to 1.57 +/- 0.13 in group A (P <or= 0.01; -8%); 2.91 +/- 0.24 to 1.88 +/- 0.16 in group B (-32%; P <or= 0.0001)). ALT decreased by 36% (59.13 +/- 4.11 vs. 30.27 +/- 1.46 IU/L; P <or= 0.001), and 42% (68.19 +/- 5.68 vs. 31.92 +/- 1.92 IU/L; P <or= 0.0001). In a multivariate analysis, fasting insulin changes in group A (P = 0.012; F = 7.150).


CONCLUSIONS
Diet and physical exercise in NAFLD children seem to lead to a significant improvement of liver function and glucose metabolism beyond any antioxidant therapy.
Nobili
V
V
Liver Unit, Bambino Gesù Children's Hospital and Research Institute, Rome, Italy.
Manco
M
M
Devito
R
R
Ciampalini
P
P
Piemonte
F
F
Marcellini
M
M
D000293:Adolescent; D000410:Alanine Transaminase / Q000378:metabolism*; D000975:Antioxidants / Q000627:therapeutic use; D001205:Ascorbic Acid / Q000627:therapeutic use; D001786:Blood Glucose / Q000378:metabolism*; D002648:Child; D002675:Child, Preschool; D005234:Fatty Liver / Q000097:blood / Q000178:diet therapy*; D005260:Female; D006801:Humans; D007333:Insulin Resistance / Q000502:physiology*; D008297:Male; D016896:Treatment Outcome; D014810:Vitamin E / Q000627:therapeutic use*
D000975:Antioxidants; D001786:Blood Glucose; D014810:Vitamin E; D000410:Alanine Transaminase; D001205:Ascorbic Acid