Identifying Predictors of Response to Vitamin E for the Treatment of Pediatric Nonalcoholic Steatohepatitis

Toshifumi Yodoshi; Sarah Orkin; Ana Catalina Arce-Clachar; Kristin Bramlage; Weizhe Su; Lin Fei; Stavra A Xanthakos; Marialena Mouzaki

doi:10.1002/jpen.1766

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Identifying Predictors of Response to Vitamin E for the Treatment of Pediatric Nonalcoholic Steatohepatitis

Journal article

Peer reviewed

Identifying Predictors of Response to Vitamin E for the Treatment of Pediatric Nonalcoholic Steatohepatitis

Toshifumi Yodoshi, Sarah Orkin, Ana Catalina Arce-Clachar, Kristin Bramlage, Weizhe Su, Lin Fei, Stavra A Xanthakos and Marialena Mouzaki

JPEN. Journal of parenteral and enteral nutrition, Vol.44(7), pp.1301-1307

09/2020

DOI: 10.1002/jpen.1766

PMID: 31985850

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Abstract

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. 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. 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. 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.

Alanine Transaminase

Biopsy

Child

Humans

Liver

Non-alcoholic Fatty Liver Disease - drug therapy

Retrospective Studies

Vitamin E

Details

Title: Subtitle: Identifying Predictors of Response to Vitamin E for the Treatment of Pediatric Nonalcoholic Steatohepatitis
Creators: Toshifumi Yodoshi - Cincinnati Children's Hospital Medical Center
Sarah Orkin - Cincinnati Children's Hospital Medical Center
Ana Catalina Arce-Clachar - Cincinnati Children's Hospital Medical Center
Kristin Bramlage - Cincinnati Children's Hospital Medical Center
Weizhe Su - University of Cincinnati
Lin Fei - University of Cincinnati Medical Center
Stavra A Xanthakos - Cincinnati Children's Hospital Medical Center
Marialena Mouzaki - Cincinnati Children's Hospital Medical Center
Resource Type: Journal article
Publication Details: JPEN. Journal of parenteral and enteral nutrition, Vol.44(7), pp.1301-1307
DOI: 10.1002/jpen.1766
PMID: 31985850
ISSN: 0148-6071
eISSN: 1941-2444
Grant note: T32 DK007727 / NIDDK NIH HHS P30 DK078392 / NIDDK NIH HHS
Language: English
Date published: 09/2020
Academic Unit: Stead Family Department of Pediatrics; Gastroenterology, Hepatology, Pancreatology, and Nutrition
Record Identifier: 9985214100202771

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