Correlation of vitamin E, uric acid, and diet composition with histologic features of pediatric NAFLD

Miriam B Vos, Ryan Colvin, Patricia Belt, Jean P Molleston, Karen F Murray, Philip Rosenthal, Jeffrey B Schwimmer, James Tonascia, Aynur Unalp, Joel E Lavine, Bradley Aouizerat, NASH CRN Research Group

Research output: Contribution to journalArticlepeer-review


OBJECTIVES: 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.

SUBJECTS AND 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.

Original languageEnglish (US)
Pages (from-to)90-6
Number of pages7
JournalJournal of Pediatric Gastroenterology and Nutrition
Issue number1
StatePublished - Jan 2012


  • Adolescent
  • Ascorbic Acid
  • Child
  • Cross-Sectional Studies
  • Diet
  • Dietary Sucrose
  • Energy Intake
  • Fatty Liver
  • Female
  • Fructose
  • Humans
  • Liver
  • Male
  • Non-alcoholic Fatty Liver Disease
  • Nutrition Assessment
  • Prospective Studies
  • Surveys and Questionnaires
  • Uric Acid
  • Vitamin E
  • Vitamin E Deficiency
  • Vitamins


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