Vitamin E or metformin may not be effective for treating liver disease in children and teens
In contrast to previous preliminary data, use of vitamin E or the diabetes drug metformin was not superior to placebo on a measured outcome for treating nonalcoholic fatty liver disease in children and adolescents, according to a study in the April 27 issue of JAMA.
"Coincident with the rise in prevalence of childhood and adolescent obesity over the past few decades, nonalcoholic fatty liver disease (NAFLD) has become the most common cause of chronic liver disease in children in the United States," according to background information in the article. NAFLD encompasses a range of severity, from mild to severe disease that may ultimately result in advanced fibrosis (development of excess fibrous connective tissue in an organ), cirrhosis, and liver cancer. Insulin resistance is frequently identified in both adults and children with NAFLD, and treatment approaches to NAFLD target reduction in insulin resistance and oxidative stress. Pediatric pilot data demonstrated potential efficacy of metformin or vitamin E in treating NAFLD.
Joel E. Lavine, M.D., Ph.D., of Columbia University, New York, and colleagues conducted a randomized-controlled trial evaluating vitamin E or metformin for the treatment of NAFLD in children. The study, conducted at 10 university clinical research centers between September 2005 and March 2010, included 173 patients (ages 8-17 years) with biopsy-confirmed NAFLD. Patients received daily dosing of 800 IU of vitamin E (58 patients), 1000 mg of metformin (57 patients), or placebo (58 patients) for 96 weeks. The predefined primary outcome measure for this trial was sustained reduction in alanine aminotransferase (ALT; an enzyme which is significantly associated with NAFLD activity score and fibrosis stage in children) defined as 50 percent or less of the baseline level or 40 U/L or less at visits every 12 weeks from 48 to 96 weeks of treatment.
The researchers found that the attainment of sustained reduction in ALT level was similar to placebo (10/58; 17 percent) in both the vitamin E (15/58; 26 percent) and metformin treatment groups (9/57; 16 percent). The average change in ALT level from baseline to 96 weeks was -35.2 U/L in the placebo group vs. -48.3 U/L in the vitamin E group and -41.7 U/L in the metformin group.
Among the 121 patients who had either NASH (nonalcoholic steatohepatitis; fatty inflammation of the liver) or borderline NASH at baseline, the resolution of NASH was significantly greater in children treated with vitamin E than with placebo (58 percent vs. 28 percent). Differences between treatment groups in terms of frequency or severity of adverse events were not significant.
"In summary, this double-blind, placebo-controlled, randomized trial of metformin or vitamin E for the treatment of NAFLD in children without diabetes or cirrhosis had a negative primary outcome. The data suggest that children treated with vitamin E who had biopsy-proven NASH or borderline NASH had significant improvement in secondary histologic outcomes with vitamin E."
"However, risk of biopsy might outweigh the benefits of therapy, so development of noninvasive markers for identification and monitoring of those who may benefit is desirable. Lifestyle modification is warranted for all children with NAFLD. The role of treatment with vitamin E in those who have a biopsy demonstrating borderline or definite NASH remains to be determined," the authors conclude.
More information: JAMA. 2011;3051659-1668.
Provided by JAMA and Archives Journals
- Encouraging findings suggest new avenues for treating liver disease in overweight Americans Oct 18, 2010 | not rated yet | 0
- NIH study offers hope to patients with nonalcoholic steatohepatitis Apr 28, 2010 | not rated yet | 0
- Non-alcoholic fatty liver disease associated with high mortality rates Jan 27, 2010 | not rated yet | 0
- Study finds certain liver disease related to cardiovascular fitness Mar 24, 2008 | not rated yet | 0
- New noninvasive liver fibrosis index reduces need for biopsies in children May 01, 2009 | not rated yet | 0
- Motion perception revisited: High Phi effect challenges established motion perception assumptions Apr 23, 2013 | 3 / 5 (2) | 2
- Anything you can do I can do better: Neuromolecular foundations of the superiority illusion (Update) Apr 02, 2013 | 4.5 / 5 (11) | 5
- The visual system as economist: Neural resource allocation in visual adaptation Mar 30, 2013 | 5 / 5 (2) | 9
- Separate lives: Neuronal and organismal lifespans decoupled Mar 27, 2013 | 4.9 / 5 (8) | 0
- Sizing things up: The evolutionary neurobiology of scale invariance Feb 28, 2013 | 4.8 / 5 (10) | 14
Classical and Quantum Mechanics via Lie algebras
Apr 15, 2011 I'd like to open a discussion thread for version 2 of the draft of my book ''Classical and Quantum Mechanics via Lie algebras'', available online at http://lanl.arxiv.org/abs/0810.1019 , and for the...
- More from Physics Forums - Independent Research
More news stories
Touted for safety, ease and patient convenience, peripherally inserted central catheters have become many clinicians' go-to for IV delivery of antibiotics, nutrition, chemotherapy, and other medications.
Diseases, Conditions, Syndromes 29 minutes ago | not rated yet | 0
Gourmands and foodies everywhere have long recognized ginger as a great way to add a little peppery zing to both sweet and savory dishes; now, a study from researchers at Columbia University shows purified components of the ...
Diseases, Conditions, Syndromes 12 hours ago | 5 / 5 (1) | 0
There are significant cost and risk factors associated with two procedures commonly used to diagnose or treat gastrointestinal problems, according to research presented at Digestive Disease Week (DDW).
Diseases, Conditions, Syndromes May 19, 2013 | not rated yet | 0
Regular consumption of coffee is associated with a reduced risk of primary sclerosing cholangitis (PSC), an autoimmune liver disease, Mayo Clinic research shows. The findings were being presented at the Digestive Disease ...
Diseases, Conditions, Syndromes May 19, 2013 | not rated yet | 0 |
A new case of the deadly coronavirus has been detected in Saudi Arabia where 15 people have already died after contracting it, the health ministry announced on Saturday on its Internet website.
Diseases, Conditions, Syndromes May 18, 2013 | not rated yet | 0
A novel study reports that white men and women of European descent inherit common foot disorders, such as bunions (hallux valgus) and lesser toe deformities, including hammer or claw toe. Findings from the Framingham Foot ...
20 minutes ago | not rated yet | 0 |
Whole-cell pertussis vaccines were more effective at protecting against pertussis than acellular pertussis vaccines during a large recent outbreak, according to a new Kaiser Permanente study published in Pediatrics.
7 minutes ago | not rated yet | 0 |
Researchers at Mayo Clinic have developed a promising method to distinguish between pancreatic cancer and chronic pancreatitis—two disorders that are difficult to tell apart. A molecular marker obtained from pancreatic ...
13 minutes ago | not rated yet | 0
Scientists at Johns Hopkins have turned their view of osteoarthritis (OA) inside out. Literally. Instead of seeing the painful degenerative disease as a problem primarily of the cartilage that cushions joints, ...
13 hours ago | 4.8 / 5 (5) | 0 |
In their quest to learn more about the variability of cells between and within tissues, biomedical scientists have devised tools capable of simultaneously measuring dozens of characteristics of individual ...
13 hours ago | 5 / 5 (3) | 0 |
Researchers at the University of Wisconsin have identified a potential new risk factor for obstructive sleep apnea: asthma. Using data from the National Institutes of Health (Heart, Lung, and Blood Institute)-funded Wisconsin ...
12 hours ago | 5 / 5 (1) | 0 |