Pediatrics, Emory University, Atlanta, GA, USA.
J Pediatr Gastroenterol Nutr. 2012 Jan;54(1):90-6. doi: 10.1097/MPG.0b013e318229da1a.
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.
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.
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).
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.
非酒精性脂肪性肝病（NAFLD）是美国儿童中最常见的慢性肝病。尽管饮食改变通常被推荐用于改善 NAFLD，但对于饮食对疾病组织学特征的影响知之甚少。
这是一项前瞻性、基于横断面注册的研究。纳入了多中心非酒精性脂肪性肝炎（NASH）临床研究网络的儿童（n=149），获得了人口统计学、人体测量学、临床、实验室和组织学数据，包括 Block 简短食物问卷。根据 NASH 临床研究网络标准，根据存在或不存在脂肪性肝炎和组织学特征的程度，将受试者分为两组。
与脂肪性肝炎患儿相比，脂肪变性患儿的脂肪、碳水化合物和蛋白质的能量比例没有显著差异。含糖饮料的消耗量较低，与组织学特征无关，尽管尿酸（果糖摄入的替代标志物）在明确的 NASH 患儿中显著增加（P=0.008）。对于所有组，维生素 E 的消耗量均低于推荐的每日允许量。脂肪变性程度较高的儿童维生素 E 的中位消耗量较低（分别为 I、II 和 III 级的 8.4、6.1 和 6.9，P=0.05）。维生素 C 摄入量较低的患儿，气球样变性增加（P=0.05）。
患有 NAFLD 的儿童饮食中维生素 E 不足，这可能导致 NAFLD 的病理生理学发生。在患有 NAFLD 的儿童中，报告的含糖饮料消耗量较低；然而，尿酸（可能反映总果糖摄入量）与 NASH 显著相关，应进一步评估。
