Effect of vitamin E on aminotransferase levels and insulin resistance in children with non-alcoholic fatty liver disease

Authors


Dr V. Nobili, Liver Unit, Research Institute, Bambino Gesu’ Children's Hospital, S. Onofrio 4 Square, 00165 Rome, Italy.
E-mail: nobili66@yahoo.it

Summary

Background  Few data are available on the effect of antioxidants in paediatric non-alcoholic fatty liver disease (NAFLD).

Aim  To compare the effect of a nutritional programme alone or combined with alpha-tocopherol and ascorbic acid on alanine aminotransferase (ALT) levels, and insulin resistance (IR) in biopsy-proven NAFLD children.

Methods  In a 12-month double-blind placebo study, 90 patients were prescribed a balanced calorie diet (25–30 cal/kg/d), physical exercise, and placebo (group A) or alpha-tocopherol 600 IU/day plus ascorbic acid 500 mg/day (group B). IR was estimated by the homeostasis model assessment (HOMA-IR).

Results  At month 12, ALT (32.67 ± 8.09 vs. 32.18 ± 11.39 IU/L; P = NS), HOMA-IR (1.52 ± 0.66 vs. 1.84 ± 0.95 IU/L; P = NS), and weight loss (32% vs. 35% of excessive body weight; P = NS) did not differ between the two arms. Among subjects who lost ≥20% of their excessive weight, ALT and body weight percentage changes were significantly related (ro = 0.260; P = 0.03). In subjects, who lost more than 1.0 kg, HOMA-IR significantly decreased (2.20 ± 0.21 to 1.57 ± 0.13 in group A (P ≤ 0.01; −8%); 2.91 ± 0.24 to 1.88 ± 0.16 in group B (−32%; P ≤ 0.0001)). ALT decreased by 36% (59.13 ± 4.11 vs. 30.27 ± 1.46 IU/L; P ≤ 0.001), and 42% (68.19 ± 5.68 vs. 31.92 ± 1.92 IU/L; P ≤ 0.0001). In a multivariate analysis, fasting insulin changes in group A (P = 0.012; F = 7.150).

Conclusions  Diet and physical exercise in NAFLD children seem to lead to a significant improvement of liver function and glucose metabolism beyond any antioxidant therapy.

Ancillary