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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


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:, 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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Alanine aminotransferase


Aspartate aminotransferase


Body mass index


Fasting blood glucose


Fasting blood insulin


Hip circumference


High-density lipoprotein


The homeostasis model assessment of insulin resistance


Liver biopsy


Low-density lipoprotein


Nonalcoholic fatty liver disease


NAFLD activity score


Standard deviation


Total cholesterol




Waist circumference


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Authors and Affiliations



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.

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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).

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