Skip to main content
Log in

Nutrition and nonalcoholic fatty liver disease in children

  • Published:
Current Diabetes Reports Aims and scope Submit manuscript

Abstract

Nonalcoholic fatty liver disease (NAFLD) is an obesity-associated liver disease found in 3% to 9% of children in the United States. NAFLD represents a spectrum of liver disease and is frequently associated with features of the metabolic syndrome. Nutrition’s role in NAFLD is complex. It does not appear that overweight children with NAFLD have an unusual diet compared with their overweight counterparts without NAFLD. It is more likely that they have increased genetic susceptibility to the general poor diet and state of positive calorie balance currently found in many children. The available treatment studies using nutrition counseling and increased physical activity are promising. We recommend initiating sustainable family-oriented lifestyle changes in all children with NAFLD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References and Recommended Reading

  1. Moran J, Ghishan F, Halter S, et al.: Steatohepatitis in obese children: a cause of chronic liver dysfunction. Am J Gastroenterol 1983, 78:374–377.

    PubMed  CAS  Google Scholar 

  2. Brunt E: Nonalcoholic steatohepatitis: definition and pathology. Semin Liver Dis 2001, 21:3–16.

    Article  PubMed  CAS  Google Scholar 

  3. Schwimmer JA, Behling C, Newbury R, et al.: Histopathology of pediatric nonalcoholic fatty liver disease. Hepatology 2005, 42:641–649.

    Article  PubMed  Google Scholar 

  4. Strauss R, Barlow S, Dietz W: Prevalence of abnormal serum aminotransferase values in overweight and obese adolescents. J Pediatr 2000, 136:727–733.

    Article  PubMed  CAS  Google Scholar 

  5. Fraser A, Longnecker M, Lawlor D: Prevalence of elevated alanine aminotransferase among US adolescents and associated factors: NHANES 1999–2004. Gastroenterology 2007, 133:1814–1820.

    Article  PubMed  CAS  Google Scholar 

  6. Sartorio A, Del Col A, Agosti F, et al.: Predictors of non-alcoholic fatty liver disease in obese children. Eur J Clin Nutr 2007, 61:877–883.

    Article  PubMed  CAS  Google Scholar 

  7. Saadeh S, Younossi Z, Remer E, et al.: The utility of radiological imaging in nonalcoholic fatty liver disease. Gastroenterology 2002, 123:745–750.

    Article  PubMed  Google Scholar 

  8. Schwimmer J, Deutsch R, Kahen T, et al.: Prevalence of fatty liver in children and adolescents. Pediatrics 2006, 118:1388–1393.

    Article  PubMed  Google Scholar 

  9. Imhof A, Kratzer W, Boehm B, et al.: Prevalence of non-alcoholic fatty liver and characteristics in overweight adolescents in the general population. Eur J Epidemiol 2007, 22:889–897.

    Article  PubMed  Google Scholar 

  10. Zhou Y, Li Y, Nie Y, et al.: Prevalence of fatty liver disease and its risk factors in the population of South China. World J Gastroenterol 2007, 13:6419–6424.

    Article  PubMed  Google Scholar 

  11. Sagi R, Reif S, Neuman G, et al.: Nonalcoholic fatty liver disease in overweight children and adolescents. Acta Paediatr 2007, 96:1209–1213.

    Article  PubMed  CAS  Google Scholar 

  12. Louthan MV, Theriot JA, Zimmerman E, et al.: Decreased prevalence of nonalcoholic fatty liver disease in black obese children. J Pediatr Gastroenterol Nutr 2005, 41:426–429.

    Article  PubMed  Google Scholar 

  13. Quiros-Tejeira R, Rivers CA, Ziba T, et al.: Risk for nonalcoholic fatty liver disease in Hispanic youth with BMI > 95th percentile. J Pediatr Gastroenterol Nutr 2007, 44:228–236.

    PubMed  CAS  Google Scholar 

  14. Manco M, Marcellini M, Devito R, et al.: Metabolic syndrome and liver histology in paediatric non-alcoholic steatohepatitis. Int J Obes (Lond) 2008, 32:381–387.

    Article  CAS  Google Scholar 

  15. Nobili V, Marcellini M, Devito R, et al.: NAFLD in children: a prospective clinical-pathological study and effect of lifestyle advice. Hepatology 2006, 44:458–465.

    Article  PubMed  Google Scholar 

  16. Patton H, Unalp A, Yates K, et al.: Metabolic syndrome among children with variable features of nonalcoholic fatty liver disease [abstract]. Hepatology 2007, 46:738A.

    Google Scholar 

  17. Burgert T, Taksali S, Sziura J, et al.: Alanine amino-transferase levels and fatty liver in childhood obesity: associations with insulin resistance, adiponectin, and visceral fat. J Clin Endocrinol Metab 2006, 91:4287–4294.

    Article  PubMed  CAS  Google Scholar 

  18. Matteoni C, Younossi Z, Gramlich T, et al.: Nonalcoholic fatty liver disease: a spectrum of clinical and pathological severity. Gastroenterology 1999, 116:1413–1419.

    Article  PubMed  CAS  Google Scholar 

  19. Adams L, Lymp J, Sauver J, et al.: The natural history of nonalcoholic fatty liver disease: a population based cohort study. Gastroenterology 2005, 129:113–121.

    Article  PubMed  Google Scholar 

  20. Fracanzani A, Burdick L, Raselli S, et al.: Carotid artery intima-media thickness in nonalcoholic fatty liver disease. Am J Med 2008, 121:72–78.

    Article  PubMed  Google Scholar 

  21. Baumeister S, Völzke H, Marschall P, et al.: Impact of fatty liver disease on health care utilization and costs in a general population: a 5-year observation. Gastroenterology 2008, 1:85–94.

    Article  Google Scholar 

  22. Herd S, Gower B, Dashti N, et al.: Body fat, fat distribution and serum lipids, lipoproteins and apolipoproteins in African-American and Caucasian-American prepubertal children. Int J Obes Relat Metab Disord 2001, 25:198–204.

    Article  PubMed  CAS  Google Scholar 

  23. D’Adamo E, Impicciatore M, Capanna R, et al.: Liver steatosis in obese prepubertal children: a possible role of insulin resistance. Obesity (Silver Spring) 2008 Jan 17 (Epub ahead of print).

  24. Cave M, Deaciuc I, Mendez C, et al.: Nonalcoholic fatty liver disease: predisposing factors and the role of nutrition. J Nutr Biochem 2007, 18:184–195.

    Article  PubMed  CAS  Google Scholar 

  25. de Piano A, Prado W, Caranti D, et al.: Metabolic and nutritional profile of obese adolescents with nonalcoholic fatty liver disease. J Pediatr Gastroenterol Nutr 2007, 44:446–452.

    Article  PubMed  CAS  Google Scholar 

  26. Fletcher K: Observations on the origin of liver fat in infantile malnutrition. Am J Clin Nutr 1966, 19:170–174.

    PubMed  CAS  Google Scholar 

  27. Musso G, Gambino R, De Michieli F, et al.: Dietary habits and their relations to insulin resistance and postprandial lipemia in nonalcoholic steatohepatitis. Hepatology 2003, 37:909–916.

    Article  PubMed  CAS  Google Scholar 

  28. Toshimitsu K, Matsuura B, Okhkubo I, et al.: Dietary habits and nutrient intake in non-alcoholic steatohepatitis. Nutrition 2007, 23:46–52.

    Article  PubMed  Google Scholar 

  29. Spear B, Barlow S, Ervin C, et al.: Recommendations for treatment of child and adolescent overweight and obesity. Pediatrics 2007, 120(Suppl 4):S254–S288.

    Article  PubMed  Google Scholar 

  30. Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein and amino acids. National Academy of Sciences website. http://www.nal.usda.gov/fnic/DRI//DRI_Energy/1319-1331.pdf. Accessed March 13, 2008.

  31. Solga S, Alkhuraishe A, Clark J, et al.: Dietary composition and nonalcoholic fatty liver disease. Dig Dis Sci 2004, 49:1578–1583.

    Article  PubMed  Google Scholar 

  32. Rodríguez-Villar C, Pérez-Heras A, Mercadé I, et al.: Comparison of a high-carbohydrate and a high-monounsaturated fat, olive oil-rich diet on the susceptibility of LDL to oxidative modification in subjects with type 2 diabetes mellitus. Diabet Med 2004, 21:142–149.

    Article  PubMed  CAS  Google Scholar 

  33. Machado M, Ravasco P, Jesus L, et al.: Blood oxidative stress markers in non-alcoholic steatohepatitis and how it correlates with diet. Scand J Gastroenterol 2008 Sep 17 (Epub ahead of print).

  34. Berglund L, Lefevre M, Ginsberg H, et al.: Comparison of monounsaturated fat with carbohydrates as a replacement for saturated fat in subjects with a high metabolic risk profile: studies in the fasting and postprandial states. Am J Clin Nutr 2007, 86:1611–1620.

    PubMed  CAS  Google Scholar 

  35. El-Badry AM, Graf R, Clavien PA: Omega 3 — omega 6: what is right for the liver? J Hepatol 2007, 47:718–725.

    Article  PubMed  CAS  Google Scholar 

  36. Zivkovic A, German J, Sanyal A: Comparative review of diets for the metabolic syndrome: implications for nonalcoholic fatty liver disease. Am J Clin Nutr 2007, 86:285–300.

    PubMed  CAS  Google Scholar 

  37. Kang H, Greenson J, Omo J, et al.: Metabolic syndrome is associated with greater histologic severity, higher carbohydrate and lower fat diet in patients with NAFLD. Am J Gastroenterol 2006, 101:2247–2253.

    Article  PubMed  CAS  Google Scholar 

  38. Havel PJ: Dietary fructose: implications for dysregulation of energy homeostasis and lipid/carbohydrate metabolism. Nutr Rev 2005, 63:133–157.

    Article  PubMed  Google Scholar 

  39. Vos MB, Blanck HN, Gillespie K, et al.: Fructose consumption in adolescents, NHANES III. J Pediatr Gastroenterol Nutr 2007, 45:E19.

    Article  Google Scholar 

  40. Morrison J, Larsen R, Glatfelter L, et al.: Inter-relationships between nutrient intake and plasma lipids and lipoproteins in schoolchildren aged 6 to 19: the Princeton School District study. Pediatrics 1980, 65:727–734.

    PubMed  CAS  Google Scholar 

  41. Kouvalainen K, Uhari M, Akerblom H, et al.: Nutrient intake and blood lipids in children [in German]. Klin Padiatr 1982, 194:307–309.

    Article  PubMed  CAS  Google Scholar 

  42. Aeberli I, Zimmermann M, Molinari L, et al.: Fructose intake is a predictor of LDL particle size in overweight schoolchildren. Am J Clin Nutr 2007, 86:1174–1178.

    PubMed  CAS  Google Scholar 

  43. Frelut M, Emery-Fillon N, Guilland J, et al.: Alanine amino transferase concentrations are linked to folate intakes and methylenetetrahydrofolate reductase polymorphism in obese adolescent girls. J Pediatr Gastroenterol Nutr 2006, 43:234–239.

    Article  PubMed  CAS  Google Scholar 

  44. Charatcharoenwitthaya P, Levy C, Angulo P, et al.: Openlabel pilot study of folic acid in patients with nonalcoholic steatohepatitis. Liver Int 2007, 27:220–226.

    Article  PubMed  CAS  Google Scholar 

  45. Nobili V, Manco N, DeVito R, et al.: Effect of vitamin E on aminotransferase levels and insulin resistance in children with non-alcoholic fatty liver disease. Aliment Pharmacol Ther 2006, 24:1553–1561.

    Article  PubMed  CAS  Google Scholar 

  46. Tock L, Prado W, Caranti D, et al.: Nonalcoholic fatty liver disease decrease in obese adolescents after multidisciplinary therapy. Eur J Gastroenterol Hepatol 2006, 18:1241–1245.

    Article  PubMed  Google Scholar 

  47. Miller E III, Pastor-Barriuso R, Dalal D, et al.: Meta-analysis: high dosage vitamin E supplementation may increase all-cause mortality. Ann Intern Med 2005, 142:37–46.

    PubMed  CAS  Google Scholar 

  48. Ji C, Kaplowitz N: Betaine decreases hyperhomocysteinemia, endoplasmic reticulum stress, and liver injury in alcohol-fed mice. Gastroenterology 2003, 124:1488–1499.

    Article  PubMed  CAS  Google Scholar 

  49. Inge T, Xanthakos S, Zeller M: Bariatric surgery for pediatric extreme obesity: now or later? Int J Obes 2007, 31:1–14.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Miriam B. Vos.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Vos, M.B., McClain, C.J. Nutrition and nonalcoholic fatty liver disease in children. Curr Diab Rep 8, 399–406 (2008). https://doi.org/10.1007/s11892-008-0069-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11892-008-0069-z

Keywords

Navigation