title: Correlation of vitamin E, uric acid, and diet composition with histologic features of pediatric NAFLD.
abstract: OBJECTIVE
  Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in children in the United States. Although changes in diet are often recommended to improve NAFLD, little is known regarding the influence of diet on histologic features of the disease.
  
  
  METHODS
  This was a prospective, cross-sectional registry-based study. Children (n = 149) enrolled in the multicenter nonalcoholic steatohepatitis (NASH) Clinical Research Network had demographic, anthropometric, clinical, laboratory, and histology data obtained, including the Block Brief Food Questionnaire. Subjects were grouped by presence or absence of steatohepatitis and grades of histologic features according to NASH Clinical Research Network criteria.
  
  
  RESULTS
  No significant differences were found between children with steatosis compared with steatohepatitis for fraction of energy from fat, carbohydrates, and protein. Sugar-sweetened beverage consumption was low and did not correlate with histologic features, although uric acid, a surrogate marker for fructose intake, was significantly increased in those with definite NASH (P = 0.008). For all groups, vitamin E consumption was insufficient compared with the recommended daily allowance. Median consumption of vitamin E was lower in children with higher grade of steatosis (8.4 vs 6.1 vs 6.9 for grades I, II, and III, respectively, P = 0.05). Those consuming less vitamin C had increased ballooning degeneration (P = 0.05).
  
  
  CONCLUSIONS
  Children with NAFLD have a diet that is insufficient in vitamin E and this may contribute to the pathophysiology of NAFLD. In children with NAFLD, reported sugar-sweetened beverage consumption is low; however, uric acid, which may reflect total fructose consumption, was significantly associated with NASH and should be further evaluated.
authors.affiliation: Pediatrics, Emory University, Atlanta, GA, USA.
authors.forename: Miriam B
authors.initials: MB
authors.lastname: Vos
authors.forename: Ryan
authors.initials: R
authors.lastname: Colvin
authors.forename: Patricia
authors.initials: P
authors.lastname: Belt
authors.forename: Jean P
authors.initials: JP
authors.lastname: Molleston
authors.forename: Karen F
authors.initials: KF
authors.lastname: Murray
authors.forename: Philip
authors.initials: P
authors.lastname: Rosenthal
authors.forename: Jeffrey B
authors.initials: JB
authors.lastname: Schwimmer
authors.forename: James
authors.initials: J
authors.lastname: Tonascia
authors.forename: Aynur
authors.initials: A
authors.lastname: Unalp
authors.forename: Joel E
authors.initials: JE
authors.lastname: Lavine
mesh_terms: D000293:Adolescent; D001205:Ascorbic Acid / Q000008:administration & dosage; D002648:Child; D003430:Cross-Sectional Studies; D004032:Diet; D019422:Dietary Sucrose / Q000008:administration & dosage; D002149:Energy Intake; D005234:Fatty Liver / Q000097:blood / Q000209:etiology* / Q000473:pathology; D005260:Female; D005632:Fructose / Q000008:administration & dosage; D006801:Humans; D008099:Liver / Q000473:pathology*; D008297:Male; D065626:Non-alcoholic Fatty Liver Disease; D015596:Nutrition Assessment; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D014527:Uric Acid / Q000097:blood*; D014810:Vitamin E / Q000008:administration & dosage*; D014811:Vitamin E Deficiency / Q000150:complications*; D014815:Vitamins / Q000008:administration & dosage
chemical_list: D019422:Dietary Sucrose; D014815:Vitamins; D014810:Vitamin E; D014527:Uric Acid; D005632:Fructose; D001205:Ascorbic Acid