Nutrition Assessment and MASH Severity in Children Using the Healthy Eating Index

Authors

Ajay Kumar Jain
Paula Buchannan
Katherine P Yates
Patricia Belt
Jeffrey B Schwimmer
Philip Rosenthal
Karen F Murray
Jean P Molleston
Ann Scheimann
Stavra A Xanthakos
Cynthia A Behling
Paula Hertel
Jamie Nilson
Brent A Neuschwander-Tetri
James Tonascia
Miriam B Vos
Nonalcoholic Steatohepatitis Clinical Research Network (NASH CRN)

Publication Date

12-1-2023

Journal

Hepatology Communications

DOI

10.1097/HC9.0000000000000320

PMID

38055641

PMCID

PMC10984667

PubMedCentral® Posted Date

12-7-2023

PubMedCentral® Full Text Version

Post-print

Published Open-Access

yes

Keywords

Humans, Male, Child, Female, Diet, Healthy, Nutrition Assessment, Lipids, Sugars, Body Weight

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.