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Appl Physiol Nutr Metab. 2017 Sep;42(9):948-954. doi: 10.1139/apnm-2016-0689. Epub 2017 May 16.

Efficacy of docosahexaenoic acid-choline-vitamin E in paediatric NASH: a randomized controlled clinical trial.

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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.
c Hepato-Metabolic Disease 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.


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.


FGF19; acide docosahexaénoïque; acides biliaires; bile acids; choline; docosahexaenoic acid; nonalcoholic fatty liver disease; steatosis; stéatose hépatique non alcoolique; vitamin E; vitamine E

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