Pediatric Department, Faculty of Medicine, Tanta University, Tanta, Egypt.
Tanta University Hospital, El Motasem Street No. 6, Tanta, Egypt.
Eur J Pediatr. 2022 Feb;181(2):579-586. doi: 10.1007/s00431-021-04243-4. Epub 2021 Aug 30.
Vitamin D is reported to have anti-inflammatory and insulin-sensitizing effects, yet vitamin D effects on hepatic fat content in children with nonalcoholic fatty liver disease (NAFLD) are not studied sufficiently. We aimed to evaluate the role of vitamin D supplementation on the hepatic fat content and NAFLD progression in children. This randomized controlled clinical trial was performed on 109 children with biopsy-proven NAFLD; only 100 patients completed the study. Patients were randomly assigned into two groups: the treatment group who received 2000 IU/day vitamin D for 6 months and the control group who received a placebo. Anthropometric measurements, vitamin D levels, aspartate aminotransferase (AST), alanine aminotransferase (ALT), total cholesterol (TC), serum triglyceride (TG), low-density lipoprotein (LDL), high-density lipoprotein (HDL), fasting blood glucose (FBG), fasting blood insulin level (FBI), homeostasis model assessment of insulin resistance (HOMA-IR), and serum calcium level were measured at the beginning and the end of the study. Liver biopsy was taken before and at the end of the study for all included children. There was a significant improvement of the hepatic steatosis and lobular inflammation by liver biopsy in the treatment group after treatment. However, there was no significant effect on the hepatocyte ballooning or hepatic fibrosis. There were significant decrease of AST, ALT, TG, LDL, FBG, FBI, and HOMA-IR and significant increase of vitamin D levels and HDL in the treatment group compared to the placebo group (P < 0.05).Conclusion: Vitamin D supplementation was found to be beneficial in the treatment of NAFLD in children.Trial registration: www.pactr.org , PACTR201710002634203. What is Known: • Nonalcoholic fatty liver disease (NAFLD) is one of the most common causes of chronic liver disease in pediatrics. • Several studies reported a negative association between low serum vitamin D level and grades of NAFLD. What is New: • Vitamin D supplementation has significantly decreased hepatic steatosis and lobular inflammation and improved the grades of NAFLD in children, confirmed by liver biopsy, but no effect on hepatocyte ballooning or fibrosis was observed. • Adjuvant vitamin D supplementation is recommended in children with NAFLD.
维生素 D 具有抗炎和胰岛素增敏作用，但维生素 D 对非酒精性脂肪性肝病 (NAFLD) 患儿肝脂肪含量的影响尚未得到充分研究。我们旨在评估维生素 D 补充对儿童肝脂肪含量和 NAFLD 进展的作用。这项随机对照临床试验在 109 名经肝活检证实为 NAFLD 的儿童中进行；只有 100 名患者完成了研究。患者被随机分为两组：治疗组每天接受 2000IU 维生素 D 治疗 6 个月，对照组接受安慰剂。在研究开始和结束时测量了体重指数、维生素 D 水平、天门冬氨酸氨基转移酶 (AST)、丙氨酸氨基转移酶 (ALT)、总胆固醇 (TC)、血清甘油三酯 (TG)、低密度脂蛋白 (LDL)、高密度脂蛋白 (HDL)、空腹血糖 (FBG)、空腹胰岛素水平 (FBI)、胰岛素抵抗的稳态模型评估 (HOMA-IR) 和血清钙水平。所有纳入的儿童均在研究开始前和结束时进行肝活检。治疗组治疗后肝脂肪变性和肝小叶炎症明显改善，但对肝细胞气球样变或肝纤维化无明显影响。与安慰剂组相比，治疗组 AST、ALT、TG、LDL、FBG、FBI 和 HOMA-IR 显著降低，维生素 D 水平和 HDL 显著升高（P<0.05）。结论：维生素 D 补充对儿童 NAFLD 的治疗有益。试验注册：www.pactr.org ，PACTR201710002634203。已知：•非酒精性脂肪性肝病 (NAFLD) 是儿科最常见的慢性肝病原因之一。•多项研究报道血清维生素 D 水平低与 NAFLD 分级呈负相关。新内容：•维生素 D 补充显著降低了儿童肝脂肪变性和肝小叶炎症，并通过肝活检改善了 NAFLD 的分级，但对肝细胞气球样变或纤维化无影响。•建议在患有 NAFLD 的儿童中辅助补充维生素 D。
