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Vitamin D and nonalcoholic fatty liver disease in children: a randomized controlled clinical trial

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A Correspondence to this article was published on 24 August 2022

A Correction to this article was published on 24 September 2021

This article has been updated

Abstract

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.

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Abbreviations

ALT:

Alanine aminotransferase

AST:

Aspartate aminotransferase

BMI:

Body mass index

FBG:

Fasting blood glucose

FBI:

Fasting blood insulin

HC:

Hip circumference

HDL:

High-density lipoprotein

HOMA-IR:

The homeostasis model assessment of insulin resistance

LB:

Liver biopsy

LDL:

Low-density lipoprotein

NAFLD:

Nonalcoholic fatty liver disease

NAS:

NAFLD activity score

SD:

Standard deviation

TC:

Total cholesterol

TG:

Triglycerides

WC:

Waist circumference

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Author information

Authors and Affiliations

  1. Pediatric Department, Faculty of Medicine, Tanta University, Tanta, Egypt

    Doaa El Amrousy & Dina Shawky

  2. Tanta University Hospital, El Motasem Street No. 6, Tanta, Egypt

    Doaa El Amrousy, Dina Abdelhai & Dina Shawky

  3. Clinical Pathology Department, Faculty of Medicine, Tanta University, Tanta, Egypt

    Dina Abdelhai

Authors
  1. Doaa El Amrousy
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  2. Dina Abdelhai
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Contributions

D.E., idea of the research; collected the study data; wrote, revised, and approved the manuscript. D.S. and D.A., performed the statistical analysis; collected the study data; wrote, revised, and approved the manuscript.

Corresponding author

Correspondence to Doaa El Amrousy.

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Ethical approval

The local ethics committee of the Faculty of Medicine, Tanta University, approved the study. The study is in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments.

Consent to participate

An informed consent was obtained from the parents of all subjects of the study before enrollment.

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The authors declare no competing interests.

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Communicated by Peter de Winter

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The original online version of this article was revised: Doaa El Amrousy and Dina Shawky should be affiliated on second affiliation instead of third affiliation.

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El Amrousy, D., Abdelhai, D. & Shawky, D. Vitamin D and nonalcoholic fatty liver disease in children: a randomized controlled clinical trial. Eur J Pediatr 181, 579–586 (2022). https://doi.org/10.1007/s00431-021-04243-4

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  • DOI: https://doi.org/10.1007/s00431-021-04243-4

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