Pediatr Gastroenterol Hepatol Nutr.  2019 May;22(3):233-241. 10.5223/pghn.2019.22.3.233.

Association Between Vitamin D Deficiency and Suspected Nonalcoholic Fatty Liver Disease in an Adolescent Population

Affiliations
  • 1Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea. kojs@snu.ac.kr
  • 2Department of Pediatrics, Korea University Medical Center, Seoul, Korea.

Abstract

PURPOSE
Vitamin D deficiency is a condition widespread throughout the world. Recent studies have suggested that vitamin D deficiency was associated with obesity and metabolic syndrome. The purpose of the study was to examine the relationship between vitamin D deficiency and nonalcoholic fatty liver disease (NAFLD) in adolescents.
METHODS
The data were obtained from the Korean National Health and Nutrition Examination Survey from 2008-2014. A total of 3,878 adolescents were included in the study. Vitamin D deficiency was defined as a 25-hydroxyvitamin D concentration <20 ng/mL and suspected NAFLD was defined as an alanine transaminase concentration >30 U/L.
RESULTS
Vitamin D deficiency was noted in 78.9% of the studied population. Age, body mass index, waist circumference, and blood pressure, glucose, cholesterol, and triglyceride levels were significantly higher in adolescents with suspected NAFLD than in adolescents without suspected NAFLD, while the mean vitamin D level was significantly lower in adolescents with suspected NAFLD. The multivariate-adjusted odds of suspected NAFLD were higher with increased age, male gender, obesity, and metabolic syndrome. Individuals with vitamin D deficiency were at higher risk of suspected NAFLD (odds ratio, 1.77; 95% confidence interval, 1.07-2.95) after adjusting for age, gender, obesity, and metabolic syndrome.
CONCLUSION
Vitamin D deficiency was associated with suspected NAFLD, independent of obesity and metabolic syndrome, in adolescents.

Keyword

Vitamin D deficiency; Nonalcoholic fatty liver disease; Alanine transaminase; Adolescent; Children; Obesity

MeSH Terms

Adolescent*
Alanine Transaminase
Blood Pressure
Body Mass Index
Child
Cholesterol
Glucose
Humans
Male
Non-alcoholic Fatty Liver Disease*
Nutrition Surveys
Obesity
Triglycerides
Vitamin D Deficiency*
Vitamin D*
Vitamins*
Waist Circumference
Alanine Transaminase
Cholesterol
Glucose
Vitamin D
Vitamins

Figure

  • Fig. 1 The density plot of log-transformed ALT levels in adolescents according to the presence or absence of vitamin D deficiency. Vitamin D deficiency is more prevalent in adolescents with ALT levels above 30 U/L (p<0.01). ALT: alanine transaminase.


Cited by  1 articles

New Perspectives in Pediatric Nonalcoholic Fatty Liver Disease: Epidemiology, Genetics, Diagnosis, and Natural History
Jae Sung Ko
Pediatr Gastroenterol Hepatol Nutr. 2019;22(6):501-510.    doi: 10.5223/pghn.2019.22.6.501.


Reference

1. Shin YH, Kim KE, Lee C, Shin HJ, Kang MS, Lee HR, et al. High prevalence of vitamin D insufficiency or deficiency in young adolescents in Korea. Eur J Pediatr. 2012; 171:1475–1480.
Article
2. Holick MF. Vitamin D deficiency. N Engl J Med. 2007; 357:266–281.
Article
3. Ford ES, Ajani UA, McGuire LC, Liu S. Concentrations of serum vitamin D and the metabolic syndrome among U.S. adults. Diabetes Care. 2005; 28:1228–1230.
Article
4. Strange RC, Shipman KE, Ramachandran S. Metabolic syndrome: a review of the role of vitamin D in mediating susceptibility and outcome. World J Diabetes. 2015; 6:896–911.
Article
5. Lim S, Kim MJ, Choi SH, Shin CS, Park KS, Jang HC, et al. Association of vitamin D deficiency with incidence of type 2 diabetes in high-risk Asian subjects. Am J Clin Nutr. 2013; 97:524–530.
Article
6. Doycheva I, Watt KD, Alkhouri N. Nonalcoholic fatty liver disease in adolescents and young adults: The next frontier in the epidemic. Hepatology. 2017; 65:2100–2109.
Article
7. Buzzetti E, Pinzani M, Tsochatzis EA. The multiple-hit pathogenesis of non-alcoholic fatty liver disease (NAFLD). Metabolism. 2016; 65:1038–1048.
Article
8. Barchetta I, Angelico F, Del Ben M, Baroni MG, Pozzilli P, Morini S, et al. Strong association between non alcoholic fatty liver disease (NAFLD) and low 25(OH) vitamin D levels in an adult population with normal serum liver enzymes. BMC Med. 2011; 9:85.
Article
9. Jablonski KL, Jovanovich A, Holmen J, Targher G, McFann K, Kendrick J, et al. Low 25-hydroxyvitamin D level is independently associated with non-alcoholic fatty liver disease. Nutr Metab Cardiovasc Dis. 2013; 23:792–798.
Article
10. Rhee EJ, Kim MK, Park SE, Park CY, Baek KH, Lee WY, et al. High serum vitamin D levels reduce the risk for nonalcoholic fatty liver disease in healthy men independent of metabolic syndrome. Endocr J. 2013; 60:743–752.
Article
11. Liangpunsakul S, Chalasani N. Serum vitamin D concentrations and unexplained elevation in ALT among US adults. Dig Dis Sci. 2011; 56:2124–2129.
Article
12. Katz K, Brar PC, Parekh N, Liu YH, Weitzman M. Suspected nonalcoholic Fatty liver disease is not associated with vitamin D status in adolescents after adjustment for obesity. J Obes. 2010; 2010:496829.
Article
13. Kweon S, Kim Y, Jang MJ, Kim Y, Kim K, Choi S, et al. Data resource profile: the Korea National Health and Nutrition Examination Survey (KNHANES). Int J Epidemiol. 2014; 43:69–77.
Article
14. Fraser A, Longnecker MP, Lawlor DA. Prevalence of elevated alanine aminotransferase among US adolescents and associated factors: NHANES 1999–2004. Gastroenterology. 2007; 133:1814–1820.
Article
15. Vos MB, Abrams SH, Barlow SE, Caprio S, Daniels SR, Kohli R, et al. NASPGHAN clinical practice guideline for the diagnosis and treatment of nonalcoholic fatty liver disease in children: recommendations from the Expert Committee on NAFLD (ECON) and the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN). J Pediatr Gastroenterol Nutr. 2017; 64:319–334.
Article
16. Kim JH, Yun S, Hwang SS, Shim JO, Chae HW, Lee YJ, et al. The 2017 Korean National Growth Charts for children and adolescents: development, improvement, and prospects. Korean J Pediatr. 2018; 61:135–149.
Article
17. Moon JS, Lee SY, Nam CM, Choi JM, Choe BK, Seo JW, et al. 2007 Korean National Growth Charts: review of developmental process and an outlook. Korean J Pediatr. 2008; 51:1–25.
Article
18. Zimmet P, Alberti KG, Kaufman F, Tajima N, Silink M, Arslanian S, et al. The metabolic syndrome in children and adolescents - an IDF consensus report. Pediatr Diabetes. 2007; 8:299–306.
Article
19. Ganji V, Zhang X, Shaikh N, Tangpricha V. Serum 25-hydroxyvitamin D concentrations are associated with prevalence of metabolic syndrome and various cardiometabolic risk factors in US children and adolescents based on assay-adjusted serum 25-hydroxyvitamin D data from NHANES 2001–2006. Am J Clin Nutr. 2011; 94:225–233.
Article
20. Nam GE, Kim DH, Cho KH, Park YG, Han KD, Kim SM, et al. 25-Hydroxyvitamin D insufficiency is associated with cardiometabolic risk in Korean adolescents: the 2008–2009 Korea National Health and Nutrition Examination Survey (KNHANES). Public Health Nutr. 2014; 17:186–194.
Article
21. Lee M, Larson R. The Korean ‘Examination Hell’: long hours of studying, distress, and depression. J Youth Adolesc. 2000; 29:249–271.
Article
22. Kim JW, Lee KJ, Yang HR, Chang JY, Moon JS, Khang YH, et al. Prevalence and risk factors of elevated alanine aminotransferase among Korean adolescents: 2001–2014. BMC Public Health. 2018; 18:617.
Article
23. Misra A, Khurana L. Obesity and the metabolic syndrome in developing countries. J Clin Endocrinol Metab. 2008; 93:S9–30.
Article
24. Jung UJ, Choi MS. Obesity and its metabolic complications: the role of adipokines and the relationship between obesity, inflammation, insulin resistance, dyslipidemia and nonalcoholic fatty liver disease. Int J Mol Sci. 2014; 15:6184–6223.
Article
25. Seo JW. Nonalcoholic fatty liver disease in children. Korean J Pediatr Gastroenterol Nutr. 2011; 14:209–221.
Article
26. Park HS, Han JH, Choi KM, Kim SM. Relation between elevated serum alanine aminotransferase and metabolic syndrome in Korean adolescents. Am J Clin Nutr. 2005; 82:1046–1051.
Article
27. Graham RC, Burke A, Stettler N. Ethnic and sex differences in the association between metabolic syndrome and suspected nonalcoholic fatty liver disease in a nationally representative sample of US adolescents. J Pediatr Gastroenterol Nutr. 2009; 49:442–449.
Article
28. Oh MS, Kim S, Jang JH, Park JY, Kang HS, Lee MS, et al. Associations among the degree of nonalcoholic fatty liver disease, metabolic syndrome, degree of obesity in children, and parental obesity. Pediatr Gastroenterol Hepatol Nutr. 2016; 19:199–206.
Article
29. Park D, Kwon H, Oh SW, Joh HK, Hwang SS, Park JH, et al. Is vitamin D an independent risk factor of nonalcoholic fatty liver disease?: a cross-sectional study of the healthy population. J Korean Med Sci. 2017; 32:95–101.
Article
30. Li L, Zhang L, Pan S, Wu X, Yin X. No significant association between vitamin D and nonalcoholic fatty liver disease in a Chinese population. Dig Dis Sci. 2013; 58:2376–2382.
Article
31. Eliades M, Spyrou E, Agrawal N, Lazo M, Brancati FL, Potter JJ, et al. Meta-analysis: vitamin D and non-alcoholic fatty liver disease. Aliment Pharmacol Ther. 2013; 38:246–254.
Article
32. Nobili V, Giorgio V, Liccardo D, Bedogni G, Morino G, Alisi A, et al. Vitamin D levels and liver histological alterations in children with nonalcoholic fatty liver disease. Eur J Endocrinol. 2014; 170:547–553.
Article
33. Chiu KC, Chu A, Go VL, Saad MF. Hypovitaminosis D is associated with insulin resistance and β cell dysfunction. Am J Clin Nutr. 2004; 79:820–825.
Article
34. Roth CL, Elfers CT, Figlewicz DP, Melhorn SJ, Morton GJ, Hoofnagle A, et al. Vitamin D deficiency in obese rats exacerbates nonalcoholic fatty liver disease and increases hepatic resistin and Toll-like receptor activation. Hepatology. 2012; 55:1103–1111.
Article
35. Nakano T, Cheng YF, Lai CY, Hsu LW, Chang YC, Deng JY, et al. Impact of artificial sunlight therapy on the progress of non-alcoholic fatty liver disease in rats. J Hepatol. 2011; 55:415–425.
Article
36. Fryar CD, Carroll MD, Ogden CL. Prevalence of obesity among children and adolescents: United States, trends 1963–1965 through 2009–2010. Hyattsville (MD): National Center for Health Statistics;2012.
37. Salmon J, Timperio A. Prevalence, trends and environmental influences on child and youth physical activity. Med Sport Sci. 2007; 50:183–199.
Article
38. Janssen I, Leblanc AG. Systematic review of the health benefits of physical activity and fitness in school-aged children and youth. Int J Behav Nutr Phys Act. 2010; 7:40.
Article
39. Robinson TN, Banda JA, Hale L, Lu AS, Fleming-Milici F, Calvert SL, et al. Screen media exposure and obesity in children and adolescents. Pediatrics. 2017; 140:S97–S101.
Article
40. Papapostoli I, Lammert F, Stokes C. Short-term vitamin D supplementation improves hepatic steatosis as quantified by controlled attenuation parameter (CAP). Z Gastroenterol. 2015; 53:KG080.
Article
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