Antioxidants Hydroxytyrosol and Vitamin E for Pediatric NAFLD

Valerio Nobili, MD; Antonella Mosca, MD


February 20, 2019

Case Presentation

Source: Alamy

A 14-year-old boy who is obese (body mass index, 27.5 kg/m2) presents with severe hepatic steatosis, as shown on ultrasound imaging.

Relevant laboratory values are as follows:

  • Hypertransaminasemia alanine transaminase, 188 U/L

  • Aspartate aminotransferase, 85 U/L

  • Homeostasis model assessment of insulin resistance, 5.4

  • Triglycerides, 210 mg/dL (>95th percentile)

  • Low-density lipoprotein, 110 mg/dL (>95th percentile)

  • High-density lipoprotein, 28 mg/dL (<5th percentile)

These results indicate that this boy also has hyperinsulinemia and dyslipidemia.

On the basis of these results, and after excluding all other causes of fatty liver, a liver biopsy was performed; this is in accordance with guidelines issued by the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition.[1]

The child was diagnosed with nonalcoholic steatohepatitis (NASH), as determined by a nonalcoholic fatty liver disease (NAFLD) Activity Score (NAS) of 7. Other notable findings included:

  • Steatosis, 3

  • Lobular inflammation, 2

  • Portal inflammation, 2

  • Ballooning, 2

  • Fibrosis, 1


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