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Efficacy of docosahexaenoic acid-choline-vitamin E in paediatric NASH: a randomized controlled clinical trial.
Appl Physiol Nutr Metab 2017; 42(9):948-954AP

Abstract

Nonalcoholic steatohepatitis (NASH), a progressive form of nonalcoholic fatty liver disease, is one of the most common hepatic diseases in children. We conducted a randomized controlled clinical trial on children with biopsy-proven NASH based on a combinatorial nutritional approach compared with placebo. Participants were assigned to lifestyle modification plus placebo or lifestyle modification plus a mix containing docosahexaenoic acid, choline, and vitamin E (DHA-CHO-VE). Forty children and adolescents participated in the entire trial. The primary outcome was the improvement of liver hyperechogenicity. Secondary outcomes included alterations of alanine aminotransferase (ALT) and other metabolic parameters. Furthermore, changes of serum bile acids (BA) and plasma fibroblast growth factor 19 (FGF19) levels were evaluated as inverse biomarkers of disease severity. At the end of the study, we observed a significant decrease in severe steatosis in the treatment group (50% to 5%, p = 0.001). Furthermore, although the anthropometric and biochemical measurements in the placebo and DHA-CHO-VE groups were comparable at baseline, at the end of the study ALT and fasting glucose levels improved only in the treatment group. Finally, we found that BA levels were not influenced whereas FGF19 levels were significantly increased by DHA-CHO-VE. The results suggest that a combination of DHA, VE, and CHO could improve steatosis and reduce ALT and glucose levels in children with NASH. However, further studies are needed to assess the impact of a DHA and VE combination on repair of liver damage in paediatric NASH.

Authors+Show Affiliations

a Department of Pediatrics and Adolescent Medicine, Medical University Graz, Graz 8036, Austria.b Liver Research Unit, Bambino Gesù Children's Hospital - IRCCS, Rome 00165, Italy.a Department of Pediatrics and Adolescent Medicine, Medical University Graz, Graz 8036, Austria.c Hepato-Metabolic Disease Unit, Bambino Gesù Children's Hospital - IRCCS, Rome 00165, Italy.c Hepato-Metabolic Disease Unit, Bambino Gesù Children's Hospital - IRCCS, Rome 00165, Italy.b Liver Research Unit, Bambino Gesù Children's Hospital - IRCCS, Rome 00165, Italy.d Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University Graz, Graz 8036, Austria.b Liver Research Unit, Bambino Gesù Children's Hospital - IRCCS, Rome 00165, Italy. c Hepato-Metabolic Disease Unit, Bambino Gesù Children's Hospital - IRCCS, Rome 00165, Italy.

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

28511023

Citation

Zöhrer, Evelyn, et al. "Efficacy of Docosahexaenoic Acid-choline-vitamin E in Paediatric NASH: a Randomized Controlled Clinical Trial." Applied Physiology, Nutrition, and Metabolism = Physiologie Appliquee, Nutrition Et Metabolisme, vol. 42, no. 9, 2017, pp. 948-954.
Zöhrer E, Alisi A, Jahnel J, et al. Efficacy of docosahexaenoic acid-choline-vitamin E in paediatric NASH: a randomized controlled clinical trial. Appl Physiol Nutr Metab. 2017;42(9):948-954.
Zöhrer, E., Alisi, A., Jahnel, J., Mosca, A., Della Corte, C., Crudele, A., ... Nobili, V. (2017). Efficacy of docosahexaenoic acid-choline-vitamin E in paediatric NASH: a randomized controlled clinical trial. Applied Physiology, Nutrition, and Metabolism = Physiologie Appliquee, Nutrition Et Metabolisme, 42(9), pp. 948-954. doi:10.1139/apnm-2016-0689.
Zöhrer E, et al. Efficacy of Docosahexaenoic Acid-choline-vitamin E in Paediatric NASH: a Randomized Controlled Clinical Trial. Appl Physiol Nutr Metab. 2017;42(9):948-954. PubMed PMID: 28511023.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Efficacy of docosahexaenoic acid-choline-vitamin E in paediatric NASH: a randomized controlled clinical trial. AU - Zöhrer,Evelyn, AU - Alisi,Anna, AU - Jahnel,Jörg, AU - Mosca,Antonella, AU - Della Corte,Claudia, AU - Crudele,Annalisa, AU - Fauler,Günter, AU - Nobili,Valerio, Y1 - 2017/05/16/ PY - 2017/5/17/pubmed PY - 2018/5/8/medline PY - 2017/5/17/entrez KW - FGF19 KW - acide docosahexaénoïque KW - acides biliaires KW - bile acids KW - choline KW - docosahexaenoic acid KW - nonalcoholic fatty liver disease KW - steatosis KW - stéatose hépatique non alcoolique KW - vitamin E KW - vitamine E SP - 948 EP - 954 JF - Applied physiology, nutrition, and metabolism = Physiologie appliquee, nutrition et metabolisme JO - Appl Physiol Nutr Metab VL - 42 IS - 9 N2 - Nonalcoholic steatohepatitis (NASH), a progressive form of nonalcoholic fatty liver disease, is one of the most common hepatic diseases in children. We conducted a randomized controlled clinical trial on children with biopsy-proven NASH based on a combinatorial nutritional approach compared with placebo. Participants were assigned to lifestyle modification plus placebo or lifestyle modification plus a mix containing docosahexaenoic acid, choline, and vitamin E (DHA-CHO-VE). Forty children and adolescents participated in the entire trial. The primary outcome was the improvement of liver hyperechogenicity. Secondary outcomes included alterations of alanine aminotransferase (ALT) and other metabolic parameters. Furthermore, changes of serum bile acids (BA) and plasma fibroblast growth factor 19 (FGF19) levels were evaluated as inverse biomarkers of disease severity. At the end of the study, we observed a significant decrease in severe steatosis in the treatment group (50% to 5%, p = 0.001). Furthermore, although the anthropometric and biochemical measurements in the placebo and DHA-CHO-VE groups were comparable at baseline, at the end of the study ALT and fasting glucose levels improved only in the treatment group. Finally, we found that BA levels were not influenced whereas FGF19 levels were significantly increased by DHA-CHO-VE. The results suggest that a combination of DHA, VE, and CHO could improve steatosis and reduce ALT and glucose levels in children with NASH. However, further studies are needed to assess the impact of a DHA and VE combination on repair of liver damage in paediatric NASH. SN - 1715-5320 UR - https://www.unboundmedicine.com/medline/citation/28511023/Efficacy_of_docosahexaenoic_acid_choline_vitamin_E_in_paediatric_NASH:_a_randomized_controlled_clinical_trial_ L2 - http://www.nrcresearchpress.com/doi/full/10.1139/apnm-2016-0689?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -