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Identifying Predictors of Response to Vitamin E for the Treatment of Pediatric Nonalcoholic Steatohepatitis
Author(s) -
Yodoshi Toshifumi,
Orkin Sarah,
ArceClachar Ana Catalina,
Bramlage Kristin,
Su Weizhe,
Fei Lin,
Xanthakos Stavra A.,
Mouzaki Marialena
Publication year - 2020
Publication title -
journal of parenteral and enteral nutrition
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.935
H-Index - 98
eISSN - 1941-2444
pISSN - 0148-6071
DOI - 10.1002/jpen.1766
Subject(s) - medicine , gastroenterology , steatosis , nonalcoholic fatty liver disease , steatohepatitis , odds ratio , vitamin , fatty liver , hepatology , disease
Background A subset of patients with nonalcoholic steatohepatitis (NASH) respond to treatment with vitamin E. The characteristics of responders are not known. The objective of this study was to investigate the outcomes of vitamin E use in clinical practice and to determine factors associated with response to treatment. Methods A pediatric cohort with NASH treated with vitamin E for 6–24 months was studied retrospectively. Vitamin E response was defined as alanine aminotransferase (ALT) normalization or >50% ALT reduction from baseline. Univariate and multivariate logistic regression was used to determine the predictors of response to vitamin E. Available paired liver biopsy data were analyzed to determine histologic response. Results Of the 151 children prescribed vitamin E, 73 met inclusion/exclusion criteria. Of those, 28 (38%) were vitamin E responders. Higher baseline serum alkaline phosphatase (ALP) levels, steatosis grade, and Nonalcoholic Fatty Liver Disease Activity Score (NAS) were associated with response to vitamin E (ALP: odds ratio [OR], 14.1; 95% CI, 1.7–118.6; steatosis: OR 2.5; 95% CI, 1.2–5.0; NAS: OR 1.6; 95% CI, 1.1–2.4). In a multivariate logistic regression model, ALP and steatosis grade rendered an area under the curve of 0.75 ( P < .001) for the prediction of response to treatment. Ballooning, NAS, and portal inflammation improved significantly with vitamin E in the subcohort (n = 15) with paired liver biopsies. Conclusions Vitamin E treatment was associated with significant ALT response in 38% of children. Baseline serum ALP levels and steatosis grade were associated with response to treatment.