Docosahexanoic Acid Plus Vitamin D Treatment Improves Features of NAFLD in Children with Serum Vitamin D Deficiency: Results from a Single Centre Trial

Abstract

BackgroundThere are no licensed treatments for non alcoholic fatty liver disease (NAFLD) in adults or children. In NAFLD, several studies have shown a benefit of omega-3 fatty acid treatment on lipid profile, insulin-sensitivity and hepatic steatosis and it has also been suggested that Vitamin D treatment has potential antifibrotic properties in liver disease.Trial DesignTo date, however, there are no studies that have tested the combination of Docosahexanoic acid (DHA) and vitamin D treatment which may benefit the whole spectrum of disease in NAFLD. Our aim therefore, was to test the effect of daily DHA (500 mg) plus vitamin D (800 IU) treatment, in obese children with biopsy-proven NAFLD and vitamin D deficiency, in a randomized, double-blind placebo-controlled trial.MethodsThe 41/43 patients completed the study (18-treatment, 23-placebo). At 12 months: i) the main outcome was liver histology improvement, defined by NAS; ii) the secondary outcome was amelioration of metabolic parameters.ResultsDHA plus vitamin D treatment reduced the NAFLD Activity Score (NAS), in the treatment group (5.4 v1.92; p<0.001 for baseline versus end of study). There was no change in fibrosis score, but a reduction of the activation of hepatic stellate cells (HSC) and fibrillar collagen content was noted (3.51±1.66 v. 1.59±1.37; p = 0.003) in treatment group. Moreover, the triglycerides (174.5 vs. 102.15 mg/dl), ALT (40.25 vs. 24.5 UI/l) and HOMA-IR (4.59 vs. 3.42) were all decreased with treatment.ConclusionDHA plus vitamin D treatment improved insulin-resistance, lipid profile, ALT and NAS. There was also decreased HSC activation and collagen content with treatment.

Peribiliary Gland Niche Participates in Biliary Tree Regeneration in Mouse and in Human Primary Sclerosing Cholangitis

“…The thickness of bile duct walls was measured by an IAS (Delta Sistemi, Rome, Italy). The extension of fibrosis was evaluated in sirius red (SR) stains . The volume occupied by PBGs was expressed as the percentage with respect to the total duct wall .…”

“…The extension of fibrosis was evaluated in sirius red (SR) stains. (15) The volume occupied by PBGs was expressed as the percentage with respect to the total duct wall. (8)(9)(10) For immunoreactions, the number of positive cells was automatically calculated by an algorithm on the entire section, and then a semiquantitative (SQ) scoring system was applied (0 = <5%; 1 = 6%-10%; 2 = 11%-30%; 3 = 31%-50%; 4 = >50%).…”

Relationship between non‐alcoholic steatohepatitis, PNPLA3 I148M genotype and bone mineral density in adolescents

“…In our study, subjects with low levels of vitamin D were excluded. Although many subjects with chronic liver disease have low levels of vitamin D, these authors failed to show any significant correlation between BMD and vitamin D levels …”

“…In all patients, serum 25‐hydroxyvitamin D [25(OH)D, vitamin D] concentration was measured by radioimmunoassay (IDS Immunodiagnostics, IDS Limited, Tyne and Wear, UK). Patients with vitamin D values <20 ng/mL were excluded …”

Treatment of Nonalcoholic Fatty Liver Disease in Children: A Systematic Review

“…In obese children with biopsy-proven NAFLD and vitamin D deficiency, DHA plus vitamin D treatment improved insulin-resistance, lipid profile, ALT, and NAS (NAFLD Activity Score) (7).…”