. 2023 Dec 7;7(12):e0320.

doi: 10.1097/HC9.0000000000000320. eCollection 2023 Dec 1.

Nutrition assessment and MASH severity in children using the Healthy Eating Index

Ajay Kumar Jain¹, Paula Buchannan¹, Katherine P Yates², Patricia Belt², Jeffrey B Schwimmer^{3

4}, Philip Rosenthal⁵, Karen F Murray⁶, Jean P Molleston⁷, Ann Scheimann⁸, Stavra A Xanthakos⁹, Cynthia A Behling^{3

10}, Paula Hertel¹¹, Jamie Nilson¹, Brent A Neuschwander-Tetri¹², James Tonascia², Miriam B Vos¹³; Nonalcoholic Steatohepatitis Clinical Research Network (NASH CRN)

Collaborators, Affiliations

Collaborators

Nonalcoholic Steatohepatitis Clinical Research Network (NASH CRN):
Laurel Cavallo, Donna Garner, Paula M Hertel, Krupa R Mysore, Taira Illescas Ortega, Mary Elizabeth Tessier, Nicole Triggs, Cynthia Tsai, Ana Catalina Arce-Clachar, Kristin Bramlage, Kim Cecil, Marialena Mouzaki, Ann Popelar, Andrew Trout, Stavra Xanthakos, Daniela Allende, Annette Bellar, Jaividhya Dasarathy, Srinivasan Dasarathy, Nicole Welch, Rahul Yerrapothu, Mustafa Bashir, Anna Mae Diehl, Cynthia Guy, Mariko Kopping, Dawn Piercy, Ayako Suzuki, Adina Alazraki, Carmen Garcia, Jorge Jara-Garra, Saul Karpen, Miriam Vos, Naga Chalasani, Mandy Cruz, Oscar W Cummings, Lisa Garrison, Samer Gawrieh, Kathryn Harlow Adams, Chaowapong Jarasvaraparn, Ann Klipsch, Jean P Molleston, Wendy Morlan, Emily Ragozzino, Niharika Samala, Raj Vuppalanchi, Pannapat Angkanaworakul, Achashman Berihun, Andrew Buysse, Theresa Dorrian, Breanna Gulati, Kris V Kowdley, Kevin Liu, Sandra Misic, Adam Sohal, Angela Anthony, Catherine Chapin, Mark H Fishbein, Danielle Carpenter, Theresa Cattoor, Janet Freebersyser, Ajay K Jain, Brent A Neuschwander-Tetri, Veeral Ajmera, Amy Alba, Cynthia Behling, Nidhi Goyal, Leila Keyvan, Rohit Loomba, Egbert Madamba, Michael S Middleton, Rebecca Morfin, Kimberly Newton, Lisa Richards, Jeffrey B Schwimmer, Seema Singh, Claude Sirlin, Jaret Skonieczny, Patricia Ugalde-Nicalo, Andrew Wang, Remilekun Awe, Ryan Gill, Bilal Hameed, Daisy Olvera, Norah Terrault, Liyun Yuan, Niviann Blondet, Randolph Otto, Matthew Yeh, Melissa Young, Somaya Albhaisi, Amon Asgharpour, Sherry Boyett, Melissa J Contos, Velimir Ac Luketic, Arun J Sanyal, Jolene Schlosser, Mohammad S Siddiqui, David E Kleiner, Peggy Adamo, Patricia Belt, Jeanne M Clark, Jennifer M DeSanto, Jill Meinert, Laura Miriel, Emily P Mitchell, Carrie Shade, Jacqueline Smith, Michael Smith, Alice Sternberg, James Tonascia, Mark L Van Natta, Annette Wagoner, Laura A Wilson, Tinsay Woreta, Katherine P Yates

Affiliations

¹ Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Saint Louis University, St. Louis, Missouri, USA.
² Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
³ Department of Pediatrics, Division of Gastroenterology, UC San Diego, La Jolla, California, USA.
⁴ Department of Gastroenterology, Rady Children's Hospital, San Diego, California, USA.
⁵ Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, University of California, San Francisco Benioff Children's Hospital, San Francisco, California, USA.
⁶ Pediatrics Institute, Cleveland Clinic and Cleveland Clinic Children's Hospital, Cleveland, Ohio.
⁷ Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Indiana University School of Medicine/Riley Hospital for Children, Indianapolis, Indiana, USA.
⁸ Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Johns Hopkins University, Baltimore, Maryland, USA.
⁹ Steatohepatitis Center, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
¹⁰ Department of Gastroenterology and Pacific Rim Pathology, San Diego, California, USA.
¹¹ Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA.
¹² Division of Gastroenterology and Hepatology, Saint Louis University, St. Louis, Missouri, USA.
¹³ Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.

PMID: 38055641
PMCID: PMC10984667
DOI: 10.1097/HC9.0000000000000320

Nutrition assessment and MASH severity in children using the Healthy Eating Index

Ajay Kumar Jain et al. Hepatol Commun. 2023.

. 2023 Dec 7;7(12):e0320.

doi: 10.1097/HC9.0000000000000320. eCollection 2023 Dec 1.

Authors

Collaborators

Nonalcoholic Steatohepatitis Clinical Research Network (NASH CRN):
Laurel Cavallo, Donna Garner, Paula M Hertel, Krupa R Mysore, Taira Illescas Ortega, Mary Elizabeth Tessier, Nicole Triggs, Cynthia Tsai, Ana Catalina Arce-Clachar, Kristin Bramlage, Kim Cecil, Marialena Mouzaki, Ann Popelar, Andrew Trout, Stavra Xanthakos, Daniela Allende, Annette Bellar, Jaividhya Dasarathy, Srinivasan Dasarathy, Nicole Welch, Rahul Yerrapothu, Mustafa Bashir, Anna Mae Diehl, Cynthia Guy, Mariko Kopping, Dawn Piercy, Ayako Suzuki, Adina Alazraki, Carmen Garcia, Jorge Jara-Garra, Saul Karpen, Miriam Vos, Naga Chalasani, Mandy Cruz, Oscar W Cummings, Lisa Garrison, Samer Gawrieh, Kathryn Harlow Adams, Chaowapong Jarasvaraparn, Ann Klipsch, Jean P Molleston, Wendy Morlan, Emily Ragozzino, Niharika Samala, Raj Vuppalanchi, Pannapat Angkanaworakul, Achashman Berihun, Andrew Buysse, Theresa Dorrian, Breanna Gulati, Kris V Kowdley, Kevin Liu, Sandra Misic, Adam Sohal, Angela Anthony, Catherine Chapin, Mark H Fishbein, Danielle Carpenter, Theresa Cattoor, Janet Freebersyser, Ajay K Jain, Brent A Neuschwander-Tetri, Veeral Ajmera, Amy Alba, Cynthia Behling, Nidhi Goyal, Leila Keyvan, Rohit Loomba, Egbert Madamba, Michael S Middleton, Rebecca Morfin, Kimberly Newton, Lisa Richards, Jeffrey B Schwimmer, Seema Singh, Claude Sirlin, Jaret Skonieczny, Patricia Ugalde-Nicalo, Andrew Wang, Remilekun Awe, Ryan Gill, Bilal Hameed, Daisy Olvera, Norah Terrault, Liyun Yuan, Niviann Blondet, Randolph Otto, Matthew Yeh, Melissa Young, Somaya Albhaisi, Amon Asgharpour, Sherry Boyett, Melissa J Contos, Velimir Ac Luketic, Arun J Sanyal, Jolene Schlosser, Mohammad S Siddiqui, David E Kleiner, Peggy Adamo, Patricia Belt, Jeanne M Clark, Jennifer M DeSanto, Jill Meinert, Laura Miriel, Emily P Mitchell, Carrie Shade, Jacqueline Smith, Michael Smith, Alice Sternberg, James Tonascia, Mark L Van Natta, Annette Wagoner, Laura A Wilson, Tinsay Woreta, Katherine P Yates

Affiliations

¹ Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Saint Louis University, St. Louis, Missouri, USA.
² Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
³ Department of Pediatrics, Division of Gastroenterology, UC San Diego, La Jolla, California, USA.
⁴ Department of Gastroenterology, Rady Children's Hospital, San Diego, California, USA.
⁵ Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, University of California, San Francisco Benioff Children's Hospital, San Francisco, California, USA.
⁶ Pediatrics Institute, Cleveland Clinic and Cleveland Clinic Children's Hospital, Cleveland, Ohio.
⁷ Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Indiana University School of Medicine/Riley Hospital for Children, Indianapolis, Indiana, USA.
⁸ Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Johns Hopkins University, Baltimore, Maryland, USA.
⁹ Steatohepatitis Center, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
¹⁰ Department of Gastroenterology and Pacific Rim Pathology, San Diego, California, USA.
¹¹ Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA.
¹² Division of Gastroenterology and Hepatology, Saint Louis University, St. Louis, Missouri, USA.
¹³ Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.

PMID: 38055641
PMCID: PMC10984667
DOI: 10.1097/HC9.0000000000000320

Abstract

Background: Pediatric metabolic-associated fatty liver disease (MAFLD) is a global health problem, with lifestyle modification as its major therapeutic strategy. Rigorous characterization of dietary content on MAFLD in children is lacking. We hypothesized an objectively measured healthier diet would positively modulate MAFLD.

Methods: Diet was assessed using the Nutrition Data System for Research in children enrolled from 10 tertiary clinical centers to determine the Healthy Eating Index (HEI, 0-100) and individual food components.

Results: In all, 119 children were included (13.3 ± 2.7 y), 80 (67%) male, 67 (18%) White, and 90 (76%) Hispanic, with an average body mass index Z-score of 2.2 ± 0.5. Diet was classified as low HEI < 47.94 (n = 39), mid HEI ≥ 47.94 and < 58.89 (n = 41), or high HEI ≥ 58.89 (n=39). Children with high HEI (healthier diet) had lower body weight (p = 0.005) and more favorable lipids. Mean serum triglycerides for low, mid, and high HEI were 163, 148, and 120 mg/dL, respectively; p = 0.04 mid versus high, p = 0.01 low versus high. Mean HDL was 38, 41 and 43 mg/dL; p = 0.02 low vs high. Less severe steatosis was noted with added sugar ≤ 10% of calories (p = 0.03). Higher lobular inflammation is associated with a higher percentage of calories from fat (OR (95% CI) = 0.95 (0.91-1.00), p = 0.04).

Conclusions: In children with MAFLD, high HEI is associated with lower body weight and more favorable lipids, while added sugar and fat intake has individual histologic features. Differential consumption of major dietary components may modify both metabolic risk factors and histologic liver injury, highlighting the importance of objective diet assessments in children with MAFLD.

Trial registration: ClinicalTrials.gov NCT01529268.

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Conflict of interest statement

Ajay Jain is a consultant for Mirum and Camp 4. Philip Rosenthal has research support from Abbvie, Albireo, Arrowhead, Gilead, Merck, Mirum, Takeda, and Travere. Philip Rosenthal is a consultant for Albireo, Audentes, BioMarin, Dicerna, Encoded, Gilead, MedinCell, Mirum, RNAV8, Takeda, Taysha, Travere. Jean Molleston reports Abbie, Albireo, Gilead, Shire, and the CF Foundation. Karen Murray reports to Albireo, Gilead, ICN Board of Directors. Brent Tetri reports to Akero, Arrowhead, Boehringer Ingelheim, BMS, Clinical Care Options, Durect, GSK, Glympse, Hepion, High Tide, HistoIndex, Labcorp, LG Chem, Madrigal, Merck, Sagimet, Senseion, Target RWE, and 89Bio; Stock options: HepGene, and HeptaBio; Institutional research grants: BMS, HighTide, Intercept, Inventiva, and Madrigal. Stavra Xanthakos reports to Target NASH. The remaining authors have no conflicts to report.

Figures

**FIGURE 1**
Shown here is the CONSORT diagram. Abbreviation: CBDR, Cysteamine bitartrate delayed-release.

See this image and copyright information in PMC

References

1. Xanthakos SA, Lavine JE, Yates KP, Schwimmer JB, Molleston JP, Rosenthal P, et al. . Progression of fatty liver disease in children receiving standard of care lifestyle advice. Gastroenterology. 2020;159:1731–1751 e1710; PMC7680281. - PMC - PubMed
1. Suri A, Song E, van Nispen J, Voigt M, Armstrong A, Murali V, et al. . Advances in the epidemiology, diagnosis, and management of pediatric fatty liver disease. Clin Ther. 2021;43:438–454. - PubMed
1. Schwimmer JB, Zepeda A, Newton KP, Xanthakos SA, Behling C, Hallinan EK, et al. . Longitudinal assessment of high blood pressure in children with nonalcoholic fatty liver disease. PLoS One. 2014;9:e112569; PMC4242611. - PMC - PubMed
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Nutrition assessment and MASH severity in children using the Healthy Eating Index

Collaborators

Affiliations

Nutrition assessment and MASH severity in children using the Healthy Eating Index

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

Substances

Associated data

Grants and funding

LinkOut - more resources

Full Text Sources

Medical