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Estimation of Fish and ω-3 Fatty Acid Intake in Pediatric Nonalcoholic Fatty Liver Disease

St-Jules, David E.*; Watters, Corilee A.*; Brunt, Elizabeth M.; Wilkens, Lynne R.*; Novotny, Rachel*; Belt, Patricia; Lavine, Joel E.§for the Nonalcoholic Steatohepatitis Clinical Research Network

Journal of Pediatric Gastroenterology and Nutrition: November 2013 - Volume 57 - Issue 5 - p 627–633
doi: 10.1097/MPG.0b013e3182a1df77
Original Articles: Hepatology and Nutrition

Aims: Fish and ω-3 fatty acids are reported to be beneficial in pediatric nonalcoholic fatty liver disease (NAFLD), but no studies have assessed their relation to histological severity. The objectives of this study were to evaluate the dietary intake of fish and ω-3 fatty acids in children with biopsy-proven NAFLD, and examine their association with serological and histological indicators of disease.

Methods: This was a cross-sectional analysis of 223 children (6–18 years) who participated in the Treatment of Nonalcoholic Fatty Liver Disease in Children trial or the NAFLD Database study conducted by the Nonalcoholic Steatohepatitis Clinical Research Network. The distribution of fish and ω-3 fatty acid intake was determined from responses to the Block Brief 2000 Food Frequency Questionnaire, and analyzed for associations with serum alanine aminotransferase, histological features of fatty liver disease, and diagnosis of steatohepatitis after adjusting for demographic, anthropometric, and dietary variables.

Results: The minority of subjects consumed the recommended 8 ounces of fish per week (22/223 [10%]) and 200 mg of long-chain ω-3 fatty acids per day (12/223 [5%]). Lack of fish and long-chain ω-3 fatty acid intake was associated with greater portal (P = 0.03 and P = 0.10, respectively) and lobular inflammation (P = 0.09 and P = 0.004, respectively) after controlling for potential confounders.

Conclusions: Fish and ω-3 fatty acid intake was insufficient in children with NAFLD, which may increase susceptibility to hepatic inflammation. Patients with pediatric NAFLD should be encouraged to consume the recommended amount of fish per week.

Supplemental Digital Content is available in the text

*University of Hawaii, Honolulu

Washington University, St Louis, MO

Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD

§Columbia University, New York, NY.

Address correspondence and reprint requests to David E. St-Jules, 1955 East-West Road, Agricultural Science Building 314 J, Honolulu, HI 96822 (e-mail:

Received 29 May, 2013

Accepted 24 June, 2013

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This study was supported by the Nonalcoholic Steatohepatitis Clinical Research Network (NASH CRN) is supported by the National Institute of Diabetes and Digestive and Kidney Diseases (grants U01DK061718, U01DK061728, U01DK061731, U01DK061732, U01DK061734, U01DK061737, U01DK061738, U01DK061730, U01DK061713), and the National Institute of Child Health and Human Development. Several clinical centers use support from the National Center for Advancing Translational Sciences in conduct of NASH CRN studies (grants UL1TR000439, UL1TR000077, UL1TR000436, UL1TR000150, UL1TR000424, UL1TR000006, UL1TR000448, UL1TR000040, UL1TR000100, UL1TR000004, UL1TR000423, UL1TR000058, UL1TR000067, UL1TR000454).

C.A.W. received a grant from the National Oceanic and Atmospheric Administration. The other authors report no conflicts of interest.

© 2013 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,