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. 2015 May;145(5):983-9.
doi: 10.3945/jn.114.208397. Epub 2015 Mar 18.

Childhood energy intake is associated with nonalcoholic fatty liver disease in adolescents

Emma L Anderson  1 , Laura D Howe  2 , Abigail Fraser  2 , Corrie Macdonald-Wallis  2 , Mark P Callaway  3 , Naveed Sattar  4 , Chris Day  5 , Kate Tilling  2 , Debbie A Lawlor  2
Affiliations

Childhood energy intake is associated with nonalcoholic fatty liver disease in adolescents

Emma L Anderson et al. J Nutr. 2015 May.

Abstract

Background: Greater adiposity is an important risk factor for nonalcoholic fatty liver disease (NAFLD). Thus, it is likely that dietary intake is involved in the development of the disease. Prospective studies assessing the relation between childhood dietary intake and risk of NAFLD are lacking.

Objective: This study was designed to explore associations between energy, carbohydrate, sugar, starch, protein, monounsaturated fat, polyunsaturated fat, saturated fat, and total fat intake by youth at ages 3, 7, and 13 y and subsequent (mean age: 17.8 y) ultrasound scan (USS)-measured liver fat and stiffness and serum alanine aminotransferase, aspartate aminotransferase, and γ-glutamyltransferase. We assessed whether observed associations were mediated through fat mass at the time of outcome assessment.

Methods: Participants were from the Avon Longitudinal Study of Parents and Children. Trajectories of energy and macronutrient intake from ages 3-13 y were obtained with linear-spline multilevel models. Linear and logistic regression models examined whether energy intake and absolute and energy-adjusted macronutrient intake at ages 3, 7, and 13 y were associated with liver outcomes.

Results: Energy intake at all ages was positively associated with liver outcomes; for example, the odds of having a USS-measured liver fat per 100 kcal increase in energy intake at age 3 y were 1.79 (95% CI: 1.14, 2.79). Associations between absolute macronutrient intake and liver outcomes were inconsistent and attenuated to the null after adjustment for total energy intake. The majority of associations attenuated to the null after adjustment for fat mass at the time liver outcomes were assessed.

Conclusion: Higher childhood and early adolescent energy intake is associated with greater NAFLD risk, and the macronutrients from which energy intake is derived are less important. These associations appear to be mediated, at least in part, by fat mass at the time of outcome assessment.

Keywords: NAFLD; childhood; diet; energy intake; fatty liver.

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Conflict of interest statement

Author disclosures: LD Howe, A Fraser, C Macdonald-Wallis, and DA Lawlor work in a unit that receives funding from the UK Medical Research Council, and EL Anderson’s studentship is funded by that grant. LD Howe, A Fraser, and C Macdonald-Wallis are funded by UK Medical Research Council postdoctoral research fellowships (MR/M009351/1, G1002375, and MR/J011932/1, respectively). DA Lawlor (NF-SI-0611-10196) is a National Institute of Health Research Senior Investigator. MP Callaway, N Sattar, C Day, and K Tilling, no conflicts of interest.

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