title: Childhood energy intake is associated with nonalcoholic fatty liver disease in adolescents.
abstract: BACKGROUND
  Greater adiposity is an important risk factor for nonalcoholic fatty liver disease (NAFLD). Thus, it is likely that dietary intake is involved in the development of the disease. Prospective studies assessing the relation between childhood dietary intake and risk of NAFLD are lacking.
  
  
  OBJECTIVE
  This study was designed to explore associations between energy, carbohydrate, sugar, starch, protein, monounsaturated fat, polyunsaturated fat, saturated fat, and total fat intake by youth at ages 3, 7, and 13 y and subsequent (mean age: 17.8 y) ultrasound scan (USS)-measured liver fat and stiffness and serum alanine aminotransferase, aspartate aminotransferase, and γ-glutamyltransferase. We assessed whether observed associations were mediated through fat mass at the time of outcome assessment.
  
  
  METHODS
  Participants were from the Avon Longitudinal Study of Parents and Children. Trajectories of energy and macronutrient intake from ages 3-13 y were obtained with linear-spline multilevel models. Linear and logistic regression models examined whether energy intake and absolute and energy-adjusted macronutrient intake at ages 3, 7, and 13 y were associated with liver outcomes.
  
  
  RESULTS
  Energy intake at all ages was positively associated with liver outcomes; for example, the odds of having a USS-measured liver fat per 100 kcal increase in energy intake at age 3 y were 1.79 (95% CI: 1.14, 2.79). Associations between absolute macronutrient intake and liver outcomes were inconsistent and attenuated to the null after adjustment for total energy intake. The majority of associations attenuated to the null after adjustment for fat mass at the time liver outcomes were assessed.
  
  
  CONCLUSIONS
  Higher childhood and early adolescent energy intake is associated with greater NAFLD risk, and the macronutrients from which energy intake is derived are less important. These associations appear to be mediated, at least in part, by fat mass at the time of outcome assessment.
authors: Medical Research Council Integrative Epidemiology Unit and School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom; Emma.louise.anderson@bristol.ac.uk.
authors: Emma L
authors: EL
authors: Anderson
authors: Medical Research Council Integrative Epidemiology Unit and School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom;
authors: Laura D
authors: LD
authors: Howe
authors: Medical Research Council Integrative Epidemiology Unit and School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom;
authors: Abigail
authors: A
authors: Fraser
authors: Medical Research Council Integrative Epidemiology Unit and School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom;
authors: Corrie
authors: C
authors: Macdonald-Wallis
authors: University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom;
authors: Mark P
authors: MP
authors: Callaway
authors: Institute of Cardiovascular & Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre, Faculty of Medicine, University of Glasgow, Glasgow, United Kingdom; and.
authors: Naveed
authors: N
authors: Sattar
authors: Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle, United Kingdom.
authors: Chris
authors: C
authors: Day
authors: Medical Research Council Integrative Epidemiology Unit and School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom;
authors: Kate
authors: K
authors: Tilling
authors: Medical Research Council Integrative Epidemiology Unit and School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom;
authors: Debbie A
authors: DA
authors: Lawlor
mesh_terms: D000293:Adolescent; D041923:Adolescent Development; D017195:Adolescent Nutritional Physiological Phenomena; D002648:Child; D002657:Child Development; D002664:Child Nutritional Physiological Phenomena; D002675:Child, Preschool; D015331:Cohort Studies; D004032:Diet / Q000009:adverse effects*; D002149:Energy Intake; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D006963:Hyperphagia / Q000503:physiopathology*; D050356:Lipid Metabolism; D008099:Liver / Q000000981:diagnostic imaging / Q000378:metabolism / Q000503:physiopathology; D008137:Longitudinal Studies; D008297:Male; D065626:Non-alcoholic Fatty Liver Disease / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D014463:Ultrasonography
keywords: NAFLD; childhood; diet; energy intake; fatty liver