title: Serum uric acid concentrations and fructose consumption are independently associated with NASH in children and adolescents.
abstract: Recent research has suggested that dietary fructose intake may increase serum uric acid (UA) concentrations. Both UA concentration and fructose consumption maybe also increase in NAFLD. It is not known whether dietary fructose consumption and UA concentration are independently associated with non-alcoholic steatohepatitis (NASH). Our aim was to investigate the factors associated with NASH in children and adolescents with proven NAFLD, and to test whether UA concentrations and fructose consumption are independently associated with NASH.
  
  
  
  Obese children with NAFLD were studied (n=271). NASH was diagnosed by a NAFLD activity score ⩾5 and the fatty liver inhibition of progression (FLIP) algorithm. Fructose consumption (g/day) was assessed by food frequency questionnaire, and UA (mg/dl) was measured in serum. Binary logistic regression with adjustment for covariates and potential confounders was undertaken to test factors independently associated with NASH.
  
  
  
  NASH occurred in 37.6% of patients. Hyperuricaemia (UA ⩾5.9mg/dl) was present in 47% of patients with NASH compared with 29.7% of non-NASH patients (p=0.003). Both UA concentration (OR=2.488, 95% CI: 1.87-2.83, p=0.004) and fructose consumption (OR=1.612, 95% CI 1.25-1.86, p=0.001) were independently associated with NASH, after adjustment for multiple (and all) measured confounders. Fructose consumption was independently associated with hyperuricaemia (OR=2.021, 95% CI: 1.66-2.78, p=0.01). These data were confirmed using the FLIP algorithm.
  
  
  
  Both dietary fructose consumption and serum UA concentrations are independently associated with NASH. Fructose consumption was the only factor independently associated with serum UA concentration.
  
  
  
  Currently, it is not known whether dietary fructose consumption and uric acid (UA) concentration are linked with non-alcoholic steatohepatitis (NASH) in children and adolescents. Our aim was to test whether UA concentrations and fructose consumption are independently associated with NASH in children and adolescents with proven non-alcoholic fatty liver disease (NAFLD). We show that both dietary fructose consumption and serum UA concentrations are independently associated with NASH and fructose consumption was independently linked with high serum UA concentrations.
authors.affiliation: Hepatometabolic Unit - Bambino Gesù Children's Hospital, Rome, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Mosca
authors.affiliation: Hepatometabolic Unit - Bambino Gesù Children's Hospital, Rome, Italy; Histopathology Unit, Bambino Gesù Hospital, IRCCS, Rome, Italy. Electronic address: nobili66@yahoo.it.
authors.forename: Valerio
authors.initials: V
authors.lastname: Nobili
authors.affiliation: Histopathology Unit, Bambino Gesù Hospital, IRCCS, Rome, Italy.
authors.forename: Rita
authors.initials: R
authors.lastname: De Vito
authors.affiliation: Liver Research Unit - Bambino Gesù Children's Hospital, Rome, Italy.
authors.forename: Annalisa
authors.initials: A
authors.lastname: Crudele
authors.affiliation: Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, United Kingdom; NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, United Kingdom.
authors.forename: Eleonora
authors.initials: E
authors.lastname: Scorletti
authors.affiliation: Paediatrics and Infectious Disease, Bambino Gesù Children Hospital, IRCCS, Rome, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Villani
authors.affiliation: Liver Research Unit - Bambino Gesù Children's Hospital, Rome, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Alisi
authors.affiliation: Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, United Kingdom; NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, United Kingdom.
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Byrne
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D005632:Fructose / Q000008:administration & dosage*; D006801:Humans; D007333:Insulin Resistance; D016015:Logistic Models; D008297:Male; D065626:Non-alcoholic Fatty Liver Disease / Q000097:blood*; D014527:Uric Acid / Q000097:blood*
chemical_list: D014527:Uric Acid; D005632:Fructose
keywords: Adolescent; Child; Diet; Fructose; Fructose consumption; Hyperuricemia; Non-alcoholic fatty liver disease (NAFLD); Non-alcoholic steatohepatitis (NASH); Obesity; Uric acid